Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation

Bax, Jeroen J.; Marwick, Thomas H.; Molhoek, Sander G.; Bleeker, Gabe B.; Erven, Lieselot van; Boersma, Eric; Steendijk, Paul; Wall, Ernst E. van der; Schalij, Martin J.

doi:10.1016/j.amjcard.2003.06.016

Cited by 389 publications

(331 citation statements)

References 13 publications

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“…18 The time delay between Ts at the LV basal lateral and septal segments (Ts-LS) was measured. 19,20 A Ts-SD12 X33 or Ts-Max X100 ms was regarded as the presence of LV systolic dyssynchrony. 21 (2) exceeding aortic valve closure on the overall 12 LV basal and midsegments (oExcT) was measured.…”

Section: Echocardiographic Assessmentmentioning

confidence: 99%

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

et al. 2012

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Dyssynchrony is common in asymptomatic patients with hypertension. We sought to investigate the impact of antihypertensive treatment on dyssynchrony in patients with hypertension. A total of sixty patients who had uncomplicated hypertension that had never been treated (treatment-naïve hypertensive patients) underwent echocardiographic evaluations of left ventricular (LV) dyssynchrony at baseline and after a 6-month treatment with antihypertensive drugs. The measured parameters were as follows:(1) the s.d. of 12 LV-segment time-to-peak systolic velocities (Ts-SD12), and (2) the maximal difference between peak systolic velocities of any 2 of the 12 segments (Ts-Max). Patients with Ts-SD12 X33 ms or Ts-Max X100 ms were regarded as having LV systolic dyssynchrony. Patients with systolic dyssynchrony (group 1, n¼29) and without systolic dyssynchrony (group 2, n¼31) were compared. Among the patients in group 1, antihypertensive treatment significantly improved LV systolic dyssynchrony (DTs-SD12, À13.1 ms; Po0.001 and DTs-Max, À34.0 ms; P¼0.003), whereas it did not demonstrate additional benefit among group 2 patients. The change in LV systolic dyssynchrony was significantly associated with changes in the mean annulus E¢ velocity, mean annulus S¢ velocity and mean annulus E¢/A¢ ratio, but not with changes in blood pressure and LV mass index. It is likely that chronic antihypertensive treatment could reverse the LV systolic dyssynchrony and simultaneously improve subclinical systolic and diastolic function in patients with hypertension and LV systolic dyssynchrony. INTRODUCTIONIt is well known that left ventricular (LV) systolic or diastolic dyssynchrony is common in patients with heart failure (HF) and a normal QRS duration. 1 There has been increased recognition that LV dyssynchrony also exists in patients without HF but with other cardiac diseases, including hypertension, 2 coronary artery disease (CAD) 3 and cardiomyopathy. 4,5 Dyssynchrony has been measured using a variety of echocardiographic parameters based on different imaging techniques, 6 including pulsed-wave tissue Doppler imaging (TDI), colorcoded TDI, tissue tracking, displacement mapping, strain and strain rate imaging, and tissue synchronization imaging. TDI is the most extensively tested method.Hypertension is a major risk factor for LV hypertrophy and HF. Epidemiological studies have demonstrated that hypertension accounts for 50% of patients with HF. 7 Recently, it was demonstrated that LV systolic dyssynchrony was present in 24% of asymptomatic patients with hypertension. 2 Moreover, on the basis of results from the previous study, 8 the proportion of treatment-naïve hypertensives with LV systolic dyssynchrony was found to be 44.5%.

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Section: Echocardiographic Assessmentmentioning

confidence: 99%

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

et al. 2012

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“…[17][18][19][20] DTI allows measurement of time intervals from electrical activity (QRS complex) to peak systolic velocity and early diastolic velocity of different regions of the myocardium for assessment of systolic and diastolic dyssynchrony. 17,23 Mechanical systolic dyssynchrony assessed by DTI is reported to be the most powerful predictor of RR after cardiac resynchronization therapy.…”

Section: Dti In Heart Failurementioning

confidence: 99%

“…[9][10][11][12][13] The recently introduced Doppler tissue imaging (DTI) technique provides unique information regarding regional myocardial function and ventricular longitudinal contractility (LC). 14 Although it is well known that DTI is useful in assessing mechanical dyssynchrony in patients with LV dysfunction receiving cardiac resynchronization therapy, [15][16][17][18][19][20][21] the prognostic implication of LC assessment has not been tested. We hypothesized that the remaining LC represents myocardial contractile reserve of biologic function, which is critical or prerequisite for RR resulting from medical treatment.…”

mentioning

confidence: 99%

Usefulness of Ventricular Longitudinal Contractility Assessed by Doppler Tissue Imaging in the Prediction of Reverse Remodeling in Patients with Severe Left Ventricular Systolic Dysfunction

Kang

Song

et al. 2006

Journal of the American Society of Echocardiography

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“…A difference greater than 60 ms (septolateral delay) was used as a substantial indicator of dyssynchrony [24][25] (fig. 4).…”

Section: Ventricular Dyssynchronymentioning

confidence: 99%

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

Silva¹,

Barretto²

2005

Arq. Bras. Cardiol.

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Heart failure is one of the major causes of mortality, morbidity, and hospitalization in patients older than 60 years, accounting for 1 to 2% of the total expenditure in the health sector in the United States (approximately 20 billion dollars per year!) 1,2 . Despite the great advances in therapy, the morbidity and mortality rates still remain high 3 . Cardiac resynchronization therapy (CRT) was introduced in the beginning of the 1990's and rapidly developed until its approval in 2001 by the FDA (Food and Drugs Administration) 4 .In the American Heart Association guidelines, CRT has been considered to be IIA evidence level 5 . Those guidelines were based on 2 large trials: the MUSTIC 6 and the MIRACLE 7 . In both, the inclusion criteria were similar: a) significant heart failure despite appropriate therapy; b) low ejection fraction; and c) broad QRS with left bundle-branch block pattern (duration>120 ms). Both studies have confirmed that CRT significantly improves symptoms, tolerance to exercise, and quality of life. Nevertheless, 20% to 30% of the patients do not improve with CRT 8 , emphasizing the need for new criteria of patients' selection.Recent studies have reported that mechanical dyssynchrony is not always related to electrical dyssynchrony 9,10 , and that the presence of ventricular dyssynchrony is the best predictor of a good response to resynchronization therapy. In reality, some patients with broad QRS may not have mechanical dyssynchrony while others with narrow QRS may [11][12][13] .Although QRS duration is a good prognostic marker for mortality in patients with heart failure and is present in more than 80% of the individuals in the 2 months preceding death 14,15 , studies comparing QRS alterations with the clinical outcome of patients seem to show little or no relation to prognosis 16 .These data suggest that electrocardiography may not be the best complementary diagnostic method for selecting candidates to CRT. Other imaging techniques, particularly the new methods for assessing ventricular function on echocardiography, seem to be better for selecting patients who will best respond to resynchronization therapy.Both the presence of broad QRS and the signs of interventricular dyssynchrony are predictors of hospitalization and severe cardiac events in patients with heart failure 17,18 . Ventricular dyssynchronyThe mechanism of dyssynchrony includes regional delays of both ventricular contraction and relaxation. The right ventricle contracts during left ventricular telediastole leading to a septal bulging towards the left ventricle. In addition, the delay in the activation of the papillary muscles causes, or worsens, mitral incompetence 19 . All such factors contribute to a reduction in the ejection fraction and a worsening of the clinical symptoms.Dyssynchrony may be inter-or intraventricular, and echocardiography may evaluate both types through several techniques.One way of evaluating interventricular dyssynchrony is by measuring the time between ventricular ejections. Conventional Doppler measure...

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Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation

Cited by 389 publications

References 13 publications

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

Usefulness of Ventricular Longitudinal Contractility Assessed by Doppler Tissue Imaging in the Prediction of Reverse Remodeling in Patients with Severe Left Ventricular Systolic Dysfunction

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

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