Prinicipal component analysis of myocardial strains to optimize cardiac resynchronization therapy patient selection

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

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Patient Selection for Cardiac Resynchronization Therapy

Circulation ◽

10.1161/01.cir.0000161276.09685.4a ◽

2005 ◽

Vol 111 (16) ◽

pp. 2146-2150 ◽

Cited By ~ 160

Author(s):

S. Adam Strickberger ◽

Jamie Conti ◽

Emile G. Daoud ◽

Edward Havranek ◽

Mandeep R. Mehra ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Selection For

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Canadian Cardiovascular Society Guidelines on the Use of Cardiac Resynchronization Therapy: Evidence and Patient Selection

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2012.10.006 ◽

2013 ◽

Vol 29 (2) ◽

pp. 182-195 ◽

Cited By ~ 38

Author(s):

Derek V. Exner ◽

David H. Birnie ◽

Gordon Moe ◽

Bernard Thibault ◽

François Philippon ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Canadian Cardiovascular Society

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Enhancing Response in the Cardiac Resynchronization Therapy Patient

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2017.08.005 ◽

2017 ◽

Vol 3 (11) ◽

pp. 1203-1219 ◽

Cited By ~ 8

Author(s):

Angelo Auricchio ◽

Frits W. Prinzen

Keyword(s):

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardiac Resynchronization Therapy Patient

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Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response.

10.22541/au.160865713.30751611/v1 ◽

2020 ◽

Author(s):

Mohammad Albatat ◽

Henrik Finsberg ◽

Hermenegild Arevalo ◽

Joakim Sundnes ◽

Jacob Bergsland ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Therapy Response ◽

Wall Stress ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Modeling Framework ◽

Fiber Stress ◽

End Diastolic Volume

Cardiac resynchronization therapy (CRT) is an effective treatment for a subgroup of heart failure patients, but more than 30 % of those selected do not respond. Inadequate criteria for patient selection and optimization are the main causes of the high non-response rate. Mechanical parameters, such as work done during the isovolumetric phase, are promising, but are complicated and require invasive measurements. In this study, we use a computational modeling framework to calculate the regional stress of the left ventricular wall of seven CRT patients and seven healthy controls. The standard deviation of the regional wall stress at the time of mitral valve closure (SD_MVC) was used to quantify dyssynchrony and was compared between patients and controls and among the patients. The results show that SD_MVC is significantly lower in controls compared to patients and correlated with the degree of long-term response among the patients based on end-diastolic volume reduction. The patients with lower SD_MVC responded best to therapy. The patient with the highest SD_MVC was the only non-responder in the cohort. The distribution of fiber stress at the beginning of the isovolumetric phase seems to correlate with the degree of response and this parameter could potentially improve patient selection and optimization of CRT. Further studies with a larger cohort are needed to validate these results.

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New echocardiographic techniques in optimal patient selection for cardiac resynchronization therapy in the treatment of chronic heart failure

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0906304p ◽

2009 ◽

Vol 137 (5-6) ◽

pp. 304-309

Author(s):

Milan Petrovic ◽

Bosiljka Vujisic-Tesic ◽

Goran Milasinovic ◽

Danijela Zamaklar-Trifunovic ◽

Ivana Nedeljkovic ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Tissue Doppler ◽

Doppler Imaging ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Selection For ◽

Consensus Report

Cardiac resynchronization therapy (CRT) has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class III or IV), a broad QRS (more than 120 ms) and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found. There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D) echocardiography, one dimensional echocardiography (M-mode), Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging - TDI, measurements of local tissue deformation indices (strain and strain rate), speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report color coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.

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The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401711010133 ◽

2017 ◽

Vol 11 (1) ◽

pp. 133-145 ◽

Cited By ~ 2

Author(s):

Michael Spartalis ◽

Eleni Tzatzaki ◽

Eleftherios Spartalis ◽

Christos Damaskos ◽

Antonios Athanasiou ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Left Bundle Branch Block ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Resynchronization Therapy ◽

Bundle Branch Block ◽

Ischaemic Cardiomyopathy ◽

Lead Placement

Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.

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The value of septal rebound stretch analysis for the prediction of volumetric response to cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa190 ◽

2020 ◽

Vol 22 (1) ◽

pp. 37-45 ◽

Cited By ~ 1

Author(s):

Odette A E Salden ◽

Alwin Zweerink ◽

Philippe Wouters ◽

Cornelis P Allaart ◽

Bastiaan Geelhoed ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Predictive Value ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Clinical Trial Registration ◽

Systolic Volume ◽

End Systolic Volume ◽

Qrs Morphology

Abstract Aims Patient selection for cardiac resynchronization therapy (CRT) may be enhanced by evaluation of systolic myocardial stretching. We evaluate whether systolic septal rebound stretch (SRSsept) derived from speckle tracking echocardiography is a predictor of reverse remodelling after CRT and whether it holds additive predictive value over the simpler visual dyssynchrony assessment by apical rocking (ApRock). Methods and results The association between SRSsept and change in left ventricular end-systolic volume (ΔLVESV) at 6 months of follow-up was assessed in 200 patients. Subsequently, the additive predictive value of SRSsept over the assessment of ApRock was evaluated in patients with and without left bundle branch block (LBBB) according to strict criteria. SRSsept was independently associated with ΔLVESV (β 0.221, P = 0.002) after correction for sex, age, ischaemic cardiomyopathy, QRS morphology and duration, and ApRock. A high SRSsept (≥optimal cut-off value 2.4) also coincided with more volumetric responders (ΔLVESV ≥ −15%) than low SRSsept in the entire cohort (70.0% and 56.4%), in patients with strict LBBB (83.3% vs. 56.7%, P = 0.024), and non-LBBB (70.7% vs. 46.3%, P = 0.004). Moreover, in non-LBBB patients, SRSsept held additional predictive information over the assessment of ApRock alone since patients that showed ApRock and high SRSsept were more often volumetric responder than those with ApRock but low SRSsept (82.8% vs. 47.4%, P = 0.001). Conclusion SRSsept is strongly associated with CRT-induced reduction in left ventricular end-systolic volume and holds additive prognostic information over QRS morphology and ApRock. Our data suggest that CRT patient selection may be improved by assessment of SRSsept, especially in the important subgroup without strict LBBB. Clinical trial registration The MARC study was registered at clinicaltrials.gov: NCT01519908.

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