Echocardiographic Examination of Atrioventricular and Interventricular Delay Optimization in Cardiac Resynchronization Therapy

Porciani, Maria Cristina; Dondina, Cristina; Macioce, Roberto; Demarchi, Gabriele; Pieragnoli, Paolo; Musilli, Nicola; Colella, Andrea; Ricciardi, Giuseppe; Michelucci, Antonio; Padeletti, Luigi

doi:10.1016/j.amjcard.2005.01.028

Cited by 98 publications

(61 citation statements)

References 9 publications

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“…This does not account for the interdependence of these variables, nor does it account for a possible nonlinear cumulative effect. Ideally, all pacing variables should be simultaneously varied, and all possible combinations should be tested (41,42,44). Furthermore, we changed AVD and VVD in sequential fashion.…”

Section: Discussionmentioning

confidence: 99%

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Quinn

Berberian

Cabreriza

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Temporary sequential biventricular pacing (BiVP) is a promising treatment for postoperative cardiac dysfunction, but the mechanism for improvement in right ventricular (RV) dysfunction is not understood. In the present study, cardiac output (CO) was optimized by sequential BiVP in six anesthetized, open-chest pigs during control and acute RV pressure overload (RVPO). Ventricular contractility was assessed by the maximum rate of increase of ventricular pressure (dP/dt max). Mechanical interventricular synchrony was measured by the area of the normalized RV-left ventricular (LV) pressure diagram (A PP ). Positive A PP indicates RV pressure preceding LV pressure, whereas zero indicates complete synchrony. In the control state, CO was maximized with nearly simultaneous stimulation of the RV and LV, which increased RV (P ϭ 0.006) and LV dP/dt max (P ϭ 0.002). During RVPO, CO was maximized with RV-first pacing, which increased RV dP/dt max (P ϭ 0.007), but did not affect LV dP/dtmax, and decreased the left-to-right, end-diastolic pressure gradient (P ϭ 0.023). Percent increase of RV dP/dt max was greater than LV dP/dtmax (P ϭ 0.014). There were no increases in end-diastolic pressure to account for increases in dP/dt max. In control and RVPO, RV dP/dtmax was linearly related to A PP (r ϭ 0.779, P Ͻ 0.001). The relation of CO to APP was curvilinear, with a peak in CO with positive A PP in the control state (P ϭ 0.004) and with A PP approaching zero during RVPO (P ϭ 0.001). These observations imply that, in our model, BiVP optimization improves CO by augmenting RV contractility. This is mediated by changes in mechanical interventricular synchrony. Afterload increases during RVPO exaggerate this effect, making CO critically dependent on simultaneous pressure generation in the RV and LV, with support of RV contractility by transmission of LV pressure across the interventricular septum. ventricular mechanics; interventricular synchrony; cardiac output; perioperative pacing; cardiac resynchronization therapy BIVENTRICULAR PACING (BiVP), or cardiac resynchronization therapy, is an important evolving therapeutic modality for congestive heart failure, reversing intraventricular conduction delay and left ventricular (LV) dysfunction intrinsic to dilated cardiomyopathy (2). In addition to long-term benefits for cardiac function and geometry in patients with various forms of chronic heart failure, BiVP is associated with acute improvements in ventricular systolic and diastolic function, inter-and intraventricular synchrony, and cardiac output (CO), with no cost to energy consumption (2). These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19, 56) and congenital (27, 40, 47) heart disease.Studies investigating sequential BiVP by alteration of the interventricular pacin...

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Section: Discussionmentioning

confidence: 99%

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Quinn

Berberian

Cabreriza

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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“…Optimum atrioventricular delay and interventricular delay were identified by the minimum MPI in each patient. 13 Echocardiographic measurements were repeated at 6-month follow-up. CRT responders at the 6-month follow-up were defined as those with a reduction of left-ventricular end-systolic volume (LVESV) more than 15%; patients were defined as nonresponders if LVESV at follow-up remained unchanged or was reduced by less than 15% compared with baseline.…”

Section: Study Protocolmentioning

confidence: 99%

“…CRT responders at the 6-month follow-up were defined as those with a reduction of left-ventricular end-systolic volume (LVESV) more than 15%; patients were defined as nonresponders if LVESV at follow-up remained unchanged or was reduced by less than 15% compared with baseline. [13][14][15][16] Blood and urine samples management Venous blood samples from heart failure patients and controls were collected into plastic tubes (BD Vacutainer, Franklin Lakes, New Jersey, USA). Serum samples were then centrifuged at 48C at 5000 r.p.m.…”

Section: Study Protocolmentioning

confidence: 99%

Metabolomic does not predict response to cardiac resynchronization therapy in patients with heart failure

Padeletti¹,

Modesti²,

Cartei³

et al. 2014

Journal of Cardiovascular Medicine

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“…1). The mechanisms responsible are increased mitral tethering forces, reduction in closing forces and mechanical and electrical dyssynchrony (5)(6)(7)(8)(19)(20)(21). As the dilating heart becomes more spherical, the papillary muscles displaces outwards and towards the apex.…”

Section: Introductionmentioning

confidence: 99%

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Güler¹,

Dündar²,

Tigen³

2011

Anadolu Kardiyol Derg

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ÖZETSistolik fonksiyonları bozuk olan genişlemiş bir kalpte, mitral kapakta yapısal bir bozukluk olmasa bile fonksiyonel olarak yetersizlik meydana gelebilir. Fonksiyonel mitral yetersizliğinin gelişmesinde birçok mekanizma beraber rol alır. Bunlar, mitral kapağı kalbin apeksine doğru çeken kuvvetlerdeki artış, sistol sırasında kapağı kapayıcı kuvvetlerdeki azalma ve mekanik ve elektriksel dissenkronidir. Papiller adele dissenkronisi de fonksiyonel mitral yetersizliğine katkıda bulunan nedenlerden biridir. Sistolik kalp yetersizliği olan hastalarda -bazı durumlarda yanıt alına-mayabilirse de-kardiyak resenkronizasyon tedavisi ile fonksiyonel mitral yetersizliğinin gerilediği bilinir. Papiller adele dissenkronisi fonksiyonel mitral yetersizliğinin gerilemesi bakımından kardiyak resenkronizasyon tedavisine yanıtı tahmin edebilir ve koroner revaskülarizasyon, mitral onarım veya kardiyak resenkronizasyon tedavisi gibi farklı tedavilerden hangisinin seçileceği ya da beraber uygulanacağı konusunda yol göste-rici olabilir. Bu derlemede fonksiyonel mitral yetersizliğinin mekanizmaları, papiller adele dissenkronisi ve fonksiyonel mitral yetersizliği arasın-daki ilişki, papiller adele dissenkronisi ile kardiyak resenkronizasyon tedavisi sonrası fonksiyonel mitral yetersizliğindeki gerileme arasındaki ilişki incelenmiştir. ABSTRACTIn a dilated heart with impaired systolic functions, functional mitral regurgitation could be seen even in the presence of structurally normal mitral apparatus. A number of mechanisms play role in the development of functional mitral regurgitation. These are increased mitral tethering forces, reduction in closing forces and mechanical and electrical dyssynchrony. Papillary muscle dyssynchrony has also been shown to be related with functional mitral regurgitation. Cardiac resynchronization therapy is known to reduce the amount of functional mitral regurgitation in patients with left ventricular systolic failure although some may not respond to treatment with cardiac resynchronization therapy. Papillary muscle dyssynchrony may predict the response of cardiac resynchronization therapy on the regression of functional mitral regurgitation and may suggest the suitable therapeutic options, such as cardiac resynchronization therapy, mitral valve repair, coronary revascularization separately or in combination. In this review, the mechanisms of functional mitral regurgitation, papillary muscle dyssynchrony and its relationship with functional mitral regurgitation and the relationship of papillary muscle dyssynchrony with the improvement of functional mitral regurgitation after cardiac resynchronization therapy are focused. (Anadolu Kardiyol Derg 2011; 11: 450-5)

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Echocardiographic Examination of Atrioventricular and Interventricular Delay Optimization in Cardiac Resynchronization Therapy

Cited by 98 publications

References 9 publications

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Metabolomic does not predict response to cardiac resynchronization therapy in patients with heart failure

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

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