Effects of physical exercise on cardiac dyssynchrony in patients with impaired left ventricular function

Kühne, Michael; Blank, Robert; Schaer, Beat; Ammann, Peter; Oßwald, Stefan; Sticherling, Christian

doi:10.1093/europace/euq465

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…Additionally, the method of stress induction had no clinically relevant effect on the determination of dyssynchrony in the population with normal MPS. This independence of dyssynchrony to exercise is also described by Kühne et al [28] for echocardiography and by Aljaroudi et al [15] for MPS in normal populations. Comparison of the normal MPS with the heart failure patients showed profound differences especially for the SD of time to peak motion ( p value <0.001) and the bandwidth ( p value <0.001).…”

Section: Discussionsupporting

confidence: 74%

Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

Veen

Younis

Ajmone-Marsan

et al. 2011

Eur J Nucl Med Mol Imaging

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PurposeLeft ventricular dyssynchrony may predict response to cardiac resynchronization therapy and may well predict adverse cardiac events. Recently, a geometrical approach for dyssynchrony analysis of myocardial perfusion scintigraphy (MPS) was introduced. In this study the feasibility of this geometrical method to detect dyssynchrony was assessed in a population with a normal MPS and in patients with documented ventricular dyssynchrony.MethodsFor the normal population 80 patients (40 men and 40 women) with normal perfusion (summed stress score ≤2 and summed rest score ≤2) and function (left ventricular ejection fraction 55–80%) on MPS were selected; 24 heart failure patients with proven dyssynchrony on MRI were selected for comparison. All patients underwent a 2-day stress/rest MPS protocol. Perfusion, function and dyssynchrony parameters were obtained by the Corridor4DM software package (Version 6.1).ResultsFor the normal population time to peak motion was 42.8 ± 5.1% RR cycle, SD of time to peak motion was 3.5 ± 1.4% RR cycle and bandwidth was 18.2 ± 6.0% RR cycle. No significant gender-related differences or differences between rest and post-stress acquisition were found for the dyssynchrony parameters. Discrepancies between the normal and abnormal populations were most profound for the mean wall motion (p value <0.001), SD of time to peak motion (p value <0.001) and bandwidth (p value <0.001).ConclusionIt is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM.

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Section: Discussionsupporting

confidence: 74%

Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

Veen

Younis

Ajmone-Marsan

et al. 2011

Eur J Nucl Med Mol Imaging

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“…fraction ,50%, QRS duration ≤120 ms, and Ts-SD ≤33 ms, which could be predicted by a higher LV filling pressure at rest. Intriguingly, in the current study by Kühne et al 13 that enrolled similar patients with symptomatic heart failure and depressed LV ejection fraction who had no dyssynchrony at rest, exercise did not lead to the development of mechanical dyssynchrony in all three groups stratified by QRS duration. Based only on the mean value of dyssynchrony measurement compared at rest and during exercise, the aforementioned conclusion appeared less comprehensive, which could have been interpreted as a 'false' neutral effect of exercise on mechanical dyssynchrony as a result of substantial individual variation in dynamic dyssynchrony during exercise, i.e.…”

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confidence: 40%

Could exercise unveil the mystery of non-response to cardiac resynchronization therapy?

Zhang

2011

Europace

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This editorial refers to 'Effects of physical exercise on cardiac dyssynchrony in patients with impaired left ventricular function' by M. Kü hne et al., on page 839.Cardiac resynchronization therapy (CRT) is an established nonpharmacological therapy for patients with advanced heart failure in the last decade. 1 Although the compelling evidence from multiple clinical trials suggests that CRT improves symptoms, exercise capacity, and cardiac function as well as reduces heart failure hospitalization and cardiovascular mortality, poor or no response to CRT is observed in about one-third of patients receiving this therapy. 2,3 It has been suggested that insufficient evidence of mechanical dyssynchrony before device implantation might be one of the major reasons, while others include the presence of transmural scar at posterolateral wall, lack of myocardial contractile reserve, severe mitral regurgitation, suboptimal left ventricular (LV) lead position, and inappropriate device programming. 2,4,5 Left ventricular mechanical dyssynchrony describes the differences in the timing of contraction between different myocardial segments that are commonly observed in patients with congestive heart failure, particularly in those with depressed LV ejection fraction. Its presence varies with not only the methods of assessment, but also characteristics of the study population including the QRS duration, loading condition, severity of coronary artery disease, LV hypertrophy, and LV remodelling. Therefore, the ECG criteria of QRS width ≥120 ms adopted in the current guidelines may not be optimal for identifying patients who will benefit most from CRT or defining the presence of mechanical dyssynchrony. 6 Analysis of LV dyssynchrony is achieved by different imaging modalities such as echocardiography, from conventional M-mode and Doppler echocardiography to more advanced tissue Doppler imaging (TDI), three-dimensional echocardiography, and speckle tracking imaging, and most of the time, performed at rest. Consequently, lack of mechanical dyssynchrony has been found in about one-third of heart failure patients with QRS duration ≥120 ms. On the other hand, mechanical dyssynchrony occurs in 40-50% of patients with a narrow QRS complex defined as ,120 ms. 7 Furthermore, numerous studies have suggested that the presence and the extent of LV mechanical dyssynchrony could be a better predictor of response to CRT than QRS duration per se. 5,8 Not until recently, the contribution of exercise to LV mechanical dyssynchrony has been investigated and exercise-induced dyssynchrony has been found to be associated with exacerbation of heart failure symptoms, an increase in mitral regurgitation, and a reduction in exercise capacity. 9 -12 Therefore, it appears that the assessment of LV mechanical dyssynchrony only at rest may not be sufficient in heart failure patients. The landmark study by Lafitte et al. 9 first described how mechanical dyssynchrony was modified by exercise in 65 consecutive patients with LV ejection fraction of ,35% and New York He...

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“…In previous CRT studies, LV function and dyssynchrony were analysed during exercise by conventional 2D variables (i.e. LVEF and aortic VTI) and TDI indices Lafitte et al, 2006;Rocchi et al, 2009;Kuhne et al, 2011;Valzania et al, 2011). However, assessment of LVEF and TDI variables is often subjective (Cho et al, 2009), and LVEF may not always reflect the real extent of myocardial impairment in patients with heart failure (Delgado et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Changes in global longitudinal strain during rest and exercise in patients treated with cardiac resynchronization therapy

Valzania

Gadler

Boriani

et al. 2012

Clin Physio Funct Imaging

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Relatively few data have been reported on prospective changes in global longitudinal strain (GLS) following cardiac resynchronization therapy (CRT), and none are available on GLS during physical exercise. We investigated the effects of CRT on GLS, assessed by speckle tracking two-dimensional (2D) echocardiography, at rest and during exercise after a mid-term follow-up. Twenty consecutive CRT patients (45% ischaemic) were assessed prospectively by speckle tracking 2D echocardiography before implant (at rest) and at mid-term follow-up (during rest and bicycle exercise). GLS, septum and lateral wall longitudinal strain, left ventricular ejection fraction (LVEF), and conventional functional variables were evaluated at baseline and follow-up. All patients completed the study protocol at rest. Exercise images were available in 90% of the patients. At follow-up, GLS improved at rest from -7.1 ± 2.6% to -9.1 ± 4.5% (P<0.01), with a further increase to -11 ± 5.1% during exercise (P<0.001). Longitudinal strain increased at rest both in the septum and in the lateral wall, with an additional increase during exercise in the lateral wall (P<0.05). GLS correlated with LVEF both at rest (r= -0.55 and r= -0.91 at baseline and 3 months, respectively; P<0.05) and during exercise (r= -0.89, P<0.05). Improvement in GLS during rest and exercise can be observed in CRT patients at mid-term follow-up and seems to correlate with changes in LVEF. GLS may be a valuable method to assess left ventricular function during rest and exercise.

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Effects of physical exercise on cardiac dyssynchrony in patients with impaired left ventricular function

Abstract: Exercise does not elicit mechanical dyssynchrony in patients without dyssynchrony at rest. In patients with significant dyssynchrony at rest, exercise-induced decrease of IVMD is common. Persistence of dyssynchrony during exercise might be a novel predictor of response to CRT.

Cited by 6 publications

References 21 publications

Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

Could exercise unveil the mystery of non-response to cardiac resynchronization therapy?

Changes in global longitudinal strain during rest and exercise in patients treated with cardiac resynchronization therapy

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