Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

Appert, Ludovic; Menet, Aymeric; Altes, Alexandre; Ennezat, Pierre Vladimir; Bardet-Bouchery, Hélène; Binda, Camille; Guyomar, Yves; Delelis, François; Castel, Anne-Laure; Goffic, Caroline Le; Guerbaaï, Raphaëlle-Ashley; Graux, P; Tribouilloy, Christophe; Maréchaux, Sylvestre

doi:10.1016/j.cjca.2018.10.019

Cited by 18 publications

(15 citation statements)

References 14 publications

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“…33 The QRS duration of CRT responders was shortened by 21 ms when compared with nonresponders, a phenomenon closely related to clinical outcomes that underscores the importance of multiparametric selection criteria. 29,30 There are important limitations to the present study and data.…”

Section: Discussionmentioning

confidence: 85%

“…We hypoth- propriate CRT candidates and monitor response to therapy. 29,30 It is important to note that while CRT responders and nonresponders had a similar pre-CRT QRS duration, the responders had a far greater number of patients with a left bundle branch block. In left bundle branch block, there is pre-ejection septal contraction (also known as "septal flash"), followed by rebound septal re-lengthening and stretch due to late posterolateral LV activation; the result is impaired septal pump function and LV ejection.…”

Section: Discussionmentioning

confidence: 99%

“…The pre‐CRT QRS segment morphology and duration are surrogate markers of LV dyssynchrony and may guide selection of appropriate CRT candidates and monitor response to therapy 29,30 . It is important to note that while CRT responders and nonresponders had a similar pre‐CRT QRS duration, the responders had a far greater number of patients with a left bundle branch block.…”

Section: Discussionmentioning

confidence: 99%

“…By pacing the LV via the coronary sinus in the setting of a left bundle branch block, CRT provides a more physiologic depolarization with left to right ventricular contraction spreading from LV apex‐to‐base to the right ventricular outflow tract 33 . The QRS duration of CRT responders was shortened by 21 ms when compared with nonresponders, a phenomenon closely related to clinical outcomes that underscores the importance of multiparametric selection criteria 29,30 …”

Section: Discussionmentioning

confidence: 99%

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Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

et al. 2020

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Background Cardiac resynchronization therapy (CRT) improves left heart geometry and function in nonischemic cardiomyopathy (NICMP). We aimed to detail the effects of CRT on left ventricular (LV) and mitral valve (MV) remodeling using 2‐dimensional transthoracic echocardiography. Methods Forty‐five consecutive patients with NICMP who underwent CRT implantation between 2009 and 2012, and had pre‐CRT and follow‐up echocardiograms available, were included. Paired t test, linear and logistic regression, and Kaplan–Meier survival analyses were used for statistical assessment. Results The mean age and QRS duration were 60 years and 157 ms, respectively, and 13 (28.9%) were female. At a mean follow‐up of 3 years, there were 22 (48.9%) “CRT responders” (≥15% reduction in LV end‐systolic volume index [LVESVi]). Significant improvements were observed in LV ejection fraction (26.3% vs 34.3%) and LVESVi (87.7 vs 71.1 mL/m2), as well as mitral regurgitation vena contracta width, MV tenting height and area, and end‐systolic interpapillary muscle distance. Five‐year actuarial survival was 87.5%. Multivariate regression analyses revealed the pre‐CRT LVESVi (β = 0.52), and MV coaptation length (β = −0.34) and septolateral annular diameter (β = 0.25) as good correlates of follow‐up LVESVi. Variables associated with CRT response were pre‐CRT MV coaptation length (OR 1.75, 95% CI 1.0‐3.1) and posterior leaflet tethering angle (OR 1.07, 95% CI 1.0‐1.14), irrespective of baseline QRS morphology and duration (all P < .05). Conclusions Cardiac resynchronization therapy improves LV and MV geometry and function in half of patients with NICMP, which is paralleled by decreased mitral regurgitation severity. The extent of pre‐CRT LV remodeling and MV tethering are associated with CRT response.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

et al. 2020

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“…This study was a retrospective analysis of a prospective registry. 18,19 CRTwas indicated in patients with HFrEF and increased QRS duration. HFrEF was defined as the presence of HF (New York Heart Association functional class II, III, or ambulatory IV) despite optimal medical treatment and LV ejection fraction (LVEF) # 35%.…”

Section: Study Population and Clinical Datamentioning

confidence: 99%

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

Riolet

Menet

Mailliet

et al. 2021

Journal of the American Society of Echocardiography

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Background:The relationship between myocardial work assessment using pressure-strain loops by echocardiography before cardiac resynchronization therapy (CRT) and response to CRT has been recently revealed. Among myocardial work parameters, the impact of left ventricular myocardial global wasted work (GWW) on response to CRT and outcome following CRT has been seldom studied. Hence, the authors evaluated the relationship between preprocedural GWW and outcome in a large prospective cohort of patients with heart failure (HF) and reduced ejection fraction receiving CRT. Methods:The study included 249 patients with HF. Myocardial work indices including GWW were calculated using speckle-tracking strain two-dimensional echocardiography using pressure-strain loops. End points of the study were (1) response to CRT, defined as left ventricular reverse remodeling and/or absence of hospitalization for HF, and (2) all-cause death during follow-up.Results: Median follow-up duration was 48 months (interquartile range, 43-54 months). Median preoperative GWW was 281 mm Hg% (interquartile range, 184-388 mm Hg%). Preoperative GWW was associated with CRT response (area under the curve, 0.74; P < .0001), and a 200 mm Hg% threshold discriminated CRT nonresponders from responders with 85% specificity and 50% sensitivity, even after adjustment for known predictors of CRT response (adjusted odds ratio, 4.03; 95% CI, 1.91-8.68; P < .001). After adjustment for established predictors of outcome in patients with HF with reduced ejection fraction receiving CRT, GWW < 200 mm Hg% remained associated with a relative increased risk for all-cause death compared with GWW $ 200 mm Hg% (adjusted hazard ratio, 2.0; 95% CI, 1.1-3.9; P = .0245). Adding GWW to a baseline model including known predictors of outcome in CRT resulted in an improvement of this model (c 2 to improve 4.85, P = .028). The relationship between GWW and CRT response and outcome was stronger in terms of size effect and statistical significance than for other myocardial work indices.Conclusions: Low preoperative GWW (<200 mm Hg%) is associated with absence of CRT response in CRT candidates and with a relative increased risk for all-cause death. GWW appears to be a promising parameter to improve selection for CRT of patients with HF with reduced ejection fraction.

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Characteristics that Predict Response After Cardiac Resynchronization Therapy

Lahiri

Chahadi

Ganesan

et al. 2020

Curr Cardiovasc Risk Rep

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Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

Cited by 18 publications

References 14 publications

Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

Characteristics that Predict Response After Cardiac Resynchronization Therapy

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