Faculty Opinions recommendation of Impact of Cardiac Resynchronization Therapy on Left Ventricular Mechanics: Understanding the Response through a New Quantitative Approach Based on Longitudinal Strain Integrals.

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

Download Full-text

Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy

Journal of Clinical Ultrasound ◽

10.1002/jcu.22687 ◽

2019 ◽

Vol 47 (6) ◽

pp. 356-365 ◽

Cited By ~ 1

Author(s):

Mengruo Zhu ◽

Haiyan Chen ◽

Zibire Fulati ◽

Yang Liu ◽

Yangang Su ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Multipoint Pacing ◽

Mechanical Dispersion

Download Full-text

Cardiac resynchronization therapy: Selection of candidates

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0039 ◽

2021 ◽

pp. 577-586

Author(s):

Victoria Delgado ◽

Jens-Uwe Voigt

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Multimodality Imaging ◽

Treatment Guideline ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Patients With Heart Failure ◽

Left Ventricular Mechanics ◽

Selection Of

Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure who remain symptomatic despite optimal medical treatment. Guideline recommendations for patient selection have been published by all major scientific societies including the ESC and are regularly updated. Unfortunately, the rate of patients who do not respond to CRT remains stable in the range of 30–40%, even in indication class I. In the selection of patients with heart failure who may benefit from cardiac resynchronization therapy (CRT), evaluation of left ventricular mechanics and dyssynchrony, extent, and location of myocardial scar and cardiac venous anatomy are most important. Multimodality imaging is pivotal to obtain this information and understand how CRT exerts its effects. This chapter will review the current state-of-the-art of multimodality imaging to select patients for CRT implantation.

Download Full-text

Cardiac resynchronization therapy: selection of candidates

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198703341.003.0030 ◽

2015 ◽

pp. 405-419

Author(s):

Victoria Delgado ◽

Jeroen J. Bax

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Myocardial Scar ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Resynchronization Therapy ◽

Venous Anatomy ◽

Ventricular Ejection Fraction ◽

Left Ventricular Mechanics ◽

Selection Of

Cardiac resynchronization therapy (CRT) is an established treatment for heart failure patients who remain symptomatic despite optimal medical treatment, with left ventricular ejection fraction <35% and QRS complex with left bundle branch block morphology or duration ≥150 ms. Non-invasive imaging modalities contribute in the evaluation and selection of patients who are candidates for CRT. Evaluation of left ventricular mechanics and dyssynchrony, extent and location of myocardial scar and cardiac venous anatomy are important to estimate the likelihood of favourable response to CRT. This chapter will review the ‘why and how’ to assess cardiac dyssynchrony, myocardial scar, and cardiac venous anatomy, prior to CRT implantation.

Download Full-text