Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Wouters, Philippe C; Leenders, Geert E.; Meine, Mathias; Prinzen, Frits W.; Doevendans, Pieter A.; Boeck, Bart W.L. De

doi:10.1007/s10554-021-02174-7

Cited by 11 publications

(17 citation statements)

References 43 publications

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“…The mechanical mechanisms associated with dysHF seem to be linked to left ventricular dyssynergistic contraction patterns resulting from dyssynchronous electrical activation leading to a shift in regional load during early myocardial contraction 33–35 . As demonstrated in figure , synergy seems to be a phenomenon linked to CRT that characterize patients responding to CRT.…”

Section: Discussionmentioning

confidence: 98%

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

et al. 2021

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AimsWe tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long-term volumetric responders [end-systolic volume (ESV) decrease >15%] in cardiac resynchronization therapy (CRT). Methods Td was analysed in an animal study (n = 12) of left bundle-branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracardiac electrodes formed a synchronicity index (SI). Pacing was performed at baseline, with LBBB, right and left ventricular pacing and finally with biventricular pacing (BIVP). We then studied Td at baseline and with BIVP in a clinical observational study in 45 patients during the implantation of CRT and followed up for up to 88 months. ResultsWe found a strong relationship between Td and SI in the animals (R = 0.84, P < 0.01). Td and SI increased from narrow QRS at baseline (Td = 95 ± 2 ms, SI = 141 ± 8 ms) to LBBB (Td = 125 ± 2 ms, SI = 247 ± 9 ms, P < 0.01), and shortened with biventricular pacing (BIVP) (Td = 113 ± 2 ms and SI = 192 ± 7 ms, P < 0.01). Prolongation of Td was associated with more wasted deformation during the preejection period (R = 0.77, P < 0.01). Six patients increased ESV by 2.5 ± 18%, while 37 responders (85%) had a mean ESV decrease of 40 ± 15% after more than 6 months of follow-up. Responders presented with a higher Td at baseline than non-responders (163 ± 26 ms vs. 121 ± 19 ms, P < 0.01). Td decreased to 156 ± 16 ms (P = 0.02) with CRT in responders, while in non-responders, Td increased to 148 ± 21 ms (P < 0.01). A decrease in Td with BIVP to values similar or below what was found at baseline accurately identified responders to therapy (AUC 0.98, P < 0.01). Td at baseline and change in Td from baseline was linear related to the decrease in ESV at follow-up. All-cause mortality was high among six non-responders (n = 4), while no patients died in the responder group during follow-up. Conclusions Prolongation of Td is associated with cardiac dyssynchrony and more wasted deformation during the preejection period. Shortening of a prolonged Td with CRT in patients accurately identifies volumetric responders to CRT with incremental value on top of current guidelines and practices. Thus, Td carries the potential to become a biomarker to predict long-term volumetric response in CRT candidates.

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Section: Discussionmentioning

confidence: 98%

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

et al. 2021

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“…[ 33 ] These investigators also demonstrated that SRS was a more sensitive marker of the mechanical substrate for CRT response than the time interval between peak shortening in the various segments. [ 33 , 34 ] More recent studies corroborated these findings by showing that the sum of postero-lateral systolic pre-stretch and septal rebound stretch, called SSI, is strongly associated with clinical outcome after CRT. [ 35 , 36 ]…”

Section: Electro-mechanics During Biventricular Pacingmentioning

confidence: 91%

Electro-energetics of Biventricular, Septal and Conduction System Pacing

Prinzen

Lumens

Duchenn

et al. 2021

Arrhythm Electrophysiol Rev

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Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.

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“…1.0 ± 2.0%) of SRSsept between different vendors was found by Van Everdingen et al, resulting in varying C-statistic values and different cut-off values [ 27 ]. Since a variability of up to 5% can be expected when measuring segmental strain [ 28 ], it is reasonable to suspect that, perhaps, similar amounts of variability were present in studies that investigated SRSsept (at rest) in a clinical setting [ 17 , 18 ]. Importantly, these studies have already proven the importance of SRSsept in the selection of patients with HF eligible for CRT, regardless of the underlying variability there.…”

Section: Discussionmentioning

confidence: 99%

“…Systolic rebound stretch of the septum (SRSsept), and acute restoration thereof, has been demonstrated as a strong predictor of response to CRT before [ 3 , 17 , 18 ]. SRSsept is a promising deformation-based parameter because it reflects myocardial work inefficiency within the septum [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility

Fixsen

Wouters

Lopata

et al. 2022

BMC Cardiovasc Disord

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Purpose Various parameters of mechanical dyssynchrony have been proposed to improve patient selection criteria for cardiac resynchronization therapy, but sensitivity and specificity are lacking. However, echocardiographic parameters are consistently investigated at rest, whereas heart failure (HF) symptoms predominately manifest during submaximal exertion. Although strain-based predictors of response are promising, feasibility and reproducibility during exercise has yet to be demonstrated. Methods Speckle-tracking echocardiography was performed in patients with HF at two separate visits. Echocardiography was performed at rest, during various exercise intensity levels, and during recovery from exercise. Systolic rebound stretch of the septum (SRSsept), systolic shortening, and septal discoordination index (SDI) were calculated. Results Echocardiography was feasible in about 70–80% of all examinations performed during exercise. Of these acquired views, 84% of the cine-loops were suitable for analysis of strain-based mechanical dyssynchrony. Test–retest variability and intra- and inter-operator reproducibility at 30% and 60% of the ventilatory threshold (VT) were about 2.5%. SDI improved in the majority of patients at 30% and 60% of the VT, with moderate to good agreement between both intensity levels. Conclusion Although various challenges remain, exercise echocardiography with strain analysis appears to be feasible in the majority of patients with dyssynchronous heart failure. Inter- and intra-observer agreement of SRSsept and SDI up to 60% of the VT were comparable to resting values. During exercise, the extent of SDI was variable, suggesting a heterogeneous response to exercise. Further research is warranted to establish its clinical significance.

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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Cited by 11 publications

References 43 publications

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

Electro-energetics of Biventricular, Septal and Conduction System Pacing

Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility

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