scholarly journals Imaging predictive factors and exercise training in CRT patients

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Ana Abreu ◽  
Helena Santa Clara
Keyword(s):  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Lv Function ◽  
Scar Burden ◽  
Intraventricular Conduction

<p>Cardiac resynchronization therapy (CRT) is an established treatment for patients with moderate-to-severe chronic heart failure (CHF) and intraventricular conduction delay, which is identified by a QRS interval of 120msec or more on a 12-lead electrocardiogram (ECG). CRT improved functional capacity, reduced hospitalizations for worsening CHF and increased survival. However, about 30-40% of patients who underwent CRT were non-responders with no clinical or echocardiographic improvement. Imaging parameters for prediction of CRT response have been reviewed. Cardiac magnetic resonance (CMR), recognized as the gold standard to assess viability, has shown to obtain good results regarding quantification of scar burden. CMR-derived measures of mechanical dyssynchrony appear to predict the outcome of CRT, however they have not been externally validated. Nuclear imaging techniques, namely single-photon emission cardiac tomography (SPECT) provide data on scar burden and location, left ventricular (LV) function, LV contraction and mechanical dyssynchrony from a single scan. The presence, location and burden of myocardial scar have been shown to affect response to CRT. However, compared to CMR, the low spatial resolution of scintigraphy might overestimate the scar extent. This problem can be overcome by positron emission tomography (PET). SPECT has also been used to quantify dyssynchrony, using phase analysis. Imaging investigation is ongoing, trying to better identifying CRT non-responders. The combination of ExT in CRT has not been well investigated; however some data show different aerobic exercise modes and intensities can further improve CRT benefits. Data available on the effects of ExT in patients with CRT have been reviewed.</p>

scholarly journals Imaging Techniques for the Assessment of Myocardial Perfusion

2016 ◽  
Vol 1 (3) ◽  
pp. 247-251
Author(s):  
Laura Jáni ◽  
Lehel Bordi ◽  
Mirabela Morariu ◽  
Tiberiu Nyulas ◽  
István Kovács ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Myocardial Perfusion ◽  
Single Photon ◽  
Imaging Techniques ◽  
Color Doppler ◽  
Photon Emission ◽  
Left Ventricular ◽  
Myocardial Imaging ◽  
Emission Computed Tomography ◽  
Emission Computed

Abstract One of the most significant causes of heart failure is coronary heart disease and subsequent left ventricular dysfunction. The prognosis and perioperative mortality are influenced by left ventricular function, which is also an important predictor marker following revascularization. The evaluation of myocardial perfusion is of utmost importance in patients who present several symptoms before choosing cardiac catheterization as treatment. The evaluation of myocardial perfusion and myocardial viability leads to superior diagnostic and treatment algorithms, thus resulting in an important improvement in the outcomes of patients with coronary artery disease. Color Doppler myocardial imaging, single-photon emission computed tomography (SPECT), contrast perfusion echocardiography, positron emission computed tomography (PET) and magnetic resonance imaging (MRI) are currently used methods for assessing myocardial perfusion. This review aims to summarize the benefits and disadvantages of each of these techniques.

Abstract 16620: The Prognostic Value of Mechanical Dyssynchrony Measured by GSPECT MPI versus Electrical Dyssnchrony Measured by QRS Duration Among Patients With an Ejection Fraction >35%

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Paul L Hess ◽  
Linda K Shaw ◽  
Sana M Al-Khatib ◽  
Zainab Samad ◽  
Eric J Velazquez ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Single Photon ◽  
Photon Emission ◽  
Mechanical Dyssynchrony ◽  
Cox Proportional Hazards ◽  
Cardiac Resynchronization ◽  
Emission Computed Tomography ◽  
Prognostic Information ◽  
Clinical Variables ◽  
Qrs Duration

Background: Whether mechanical dyssynchrony measured by phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging (GSPECT MPI) adds prognostic information to electrical dyssynchrony or is is associated with death among patients with an EF >35% is incompletely understood. Methods: We identified consecutive patients with angiographically significant coronary disease who underwent GSPECT MPI in the Duke Databank for Cardiovascular Disease between July 2003 and May 2009. Serial Cox proportional hazards models consisting of clinical variables only, clinical variables plus electrical dyssynchrony as measured by QRS duration, clinical variables plus mechanical dyssynchrony according to the duration of the cardiac cycle during which 95% of the ventricle is initiating contraction (phase bandwidth),and a final model inclusive of all of these variables were fitted. Results: A total of 1,157 patients were identified. The median age was 64 (interquartile range (IQR) 55-72 years). Patients were predominantly white (73.8%), of male sex (67.7%), and had hypertension (76.7%). A minority had congestive heart failure (21.9%), peripheral vascular disease (10.5%), and cerebrovascular disease (12.2%). The median QRS duration was 92 (IQR 84-103) ms, while the median bandwidth was 58 (IQR 41-90)°. The median duration of follow-up was 4.3 (IQR 3.0-6.4) years. A total of 293 deaths were observed. Mechanical dyssynchrony added prognostic information independent of standard clinical variables and electrical dyssynchrony (Figure). Conclusions: Mechanical dyssynchrony measured by GSPECT MPI is independently associated with death and adds prognostic information above that provided by standard clinical covariates and electrical dyssynchrony among patients with an EF>35%. Whether cardiac resynchronization therapy improves outcomes among patients with mechanical dyssynchrony measured by GSPECT requires further study.

Measurement of troponin I 48h after admission as a tool to rule out impaired left ventricular function in patients with a first myocardial infarction

2005 ◽  
Vol 43 (8) ◽  
Author(s):  
Mauro Panteghini ◽  
Graziella Bonetti ◽  
Franca Pagani ◽  
Francesca Stefini ◽  
Raffaele Giubbini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Single Photon ◽  
Single Point ◽  
Photon Emission ◽  
Left Ventricular ◽  
Lv Function ◽  
Emission Computed Tomography ◽  
First Myocardial Infarction

AbstractFew studies have evaluated cardiac troponin I (cTnI) as a marker for infarct size and left ventricular (LV) dysfunction. Here we investigated the ability of a single-point cTnI, measured with a second-generation assay (Access AccuTnI), to estimate infarct size and assess LV function in patients with a first myocardial infarction (AMI). cTnI measurements were performed 12 and 48h after admission in 63 consecutive AMI patients. LV function was evaluated by gated single-photon emission computed tomography (SPECT) and infarct size was estimated by CK-MB peak and SPECT myocardial perfusion. LV function and infarct size were evaluated by SPECT before hospital discharge. SPECT was also repeated 3months later. Significant correlations (p<0.001) were found between cTnI at 12 and 48h and both the peak CK-MB (r=0.61 and r=0.82, respectively) and the perfusion defect size at SPECT (r=0.55 and r=0.61, respectively). cTnI at 12 and 48h were inversely related (p<0.001) to LV ejection fraction (LVEF) assessed both early (r=–0.45 and r=–0.57, respectively) and 3months after AMI (r=–0.51 and r=–0.69, respectively). cTnI >14.8 μg/L at 48h predicted an LVEF <40% at 3months with a sensitivity of 100% [95% confidence interval (CI) 73.5–100%], specificity of 65% (CI 49–79%), and a negative predictive value of 100%. Our findings demonstrate that a single cTnI measurement 48h after admission is useful for ruling out impaired LV function in a routine clinical setting.

scholarly journals Echocardiographic estimation of acute haemodynamic response during optimization of multisite pace-maker using different pacing modalities and atrioventricular delays

2009 ◽  
Vol 66 (5) ◽  
pp. 365-370 ◽  
Author(s):  
Sonja Salinger-Martinovic ◽  
Zoran Perisic ◽  
Dragan Milic ◽  
Svetlana Apostolovic ◽  
Miloje Tomasevic ◽  
...  
Keyword(s):  
Left Ventricular Systolic Dysfunction ◽  
Severe Heart Failure ◽  
Pressure Rise ◽  
Optimization Procedure ◽  
Left Ventricular ◽  
Haemodynamic Response ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Intraventricular Conduction ◽  
Haemodynamic Changes

Background/Aim. Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in symptoms, quality of life and prognosis in patients with severe heart failure and intraventricular conduction delay. Different pacing modalities produce variable activation patterns and may be a cause of different haemodynamic changes. The aim of our study was to investigate acute haemodynamic changes with different CRT configurations during optimization procedure. Methods. This study included 30 patients with severe left ventricular systolic dysfunction and left bundle branch block with wide QRS (EF 24.33 ? 3.7%, QRS 159 ? 17.3 ms, New York Heart Association III/IV 25/5) with implanted CRT device. The whole group of patients had severe mitral regurgitation in order to measure dP/dt. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left and right ventricular pre-ejection intervals (LVPEI and RVPEI), interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 170.5 ? 24.6 to 145.9 ? 9.5 (p < 0.001), RVPEI from 102.4 ? 15.9 to 119.8 ? 10.9 (p < 0.001), IVD from 68.1 ? 18.3 to 26.5 ? 8.2 (p < 0.001) and dP/dt from 524.2 ? 67 to 678.2 ? 88.5 (p < 0.01). Conclusion. In patients receiving CRT echocardiographic assessment of the acute haemodynamic response to CRT is a useful tool in optimization procedure. The variability of Doppler parameters with different CRT modalities emphasizes the necessity of individualized approach in optimization procedure.

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