long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay

Auricchio, Angelo; Stellbrink, Christoph; Sack, Stefan; Block, Michael S.; Vogt, Jürgen; Bakker, Patricia F.A.; Huth, Christof; Schöndube, Friedrich A.; Wolfhard, U.; Böcker, Dirk; Krahnefeld, Olaf; Kirkels, Hans

doi:10.1016/s0735-1097(02)01895-8

Cited by 891 publications

(539 citation statements)

References 26 publications

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“…CRT improves left ventricular (LV) function, increases exercise capacity, improves heart failure symptoms, and reduces hospitalizations and mortality (1)(2)(3)(4)(5)(6). Patients are chosen for CRT based on the presence of a prolonged QRS interval (Ͼ120 msec) on a surface electrocardiogram (2,3,6,7). Prolonged QRS duration has been used as an index of dyssynchrony, with a longer QRS interval corresponding to a greater degree of dyssynchrony (8).…”

mentioning

confidence: 99%

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Delfino

Bhasin

Cole

et al. 2006

Magnetic Resonance Imaging

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Purpose: To compare longitudinal myocardial velocity and time to peak longitudinal velocity obtained with magnetic resonance phase velocity mapping (MR-PVM) and tissue Doppler imaging (TDI), and to assess the reproducibility of each method. Materials and Methods:Longitudinal myocardial velocity was measured by TDI and MR-PVM in 10 normal volunteers and 10 patients with dyssynchrony. The reproducibility of MR-PVM and TDI was assessed on repeated measurements in the 10 normal volunteers.Results: MR and TDI measurements of longitudinal myocardial velocity correlated well (r ϭ 0.86) in both normal subjects and patients with dyssynchrony. However, myocardial velocities measured with MR consistently exceeded velocities measured with TDI. MR and TDI agreed strongly in measuring the time to peak velocity (r ϭ 0.97). The reproducibility of TDI and MR-PVM appeared similar in measuring peak velocities (13.1% vs. 11.0%, respectively; P ϭ NS) and time to peak velocity (9.1% vs. 5.7%, respectively; P ϭ NS). Conclusion:Excellent correlation and reproducibility were observed between MR-PVM and TDI in measuring longitudinal myocardial velocity and time to peak velocity in both normal subjects and patients with dyssynchrony.

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mentioning

confidence: 99%

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Delfino

Bhasin

Cole

et al. 2006

Magnetic Resonance Imaging

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“…[1][2][3] CRT improves left ventricular systolic and diastolic function 4 and clinical status 5 and reduces functional mitral regurgitation (MR). 6 Whether CRT significantly affects exercise-induced changes in MR has never been investigated.…”

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confidence: 99%

“…Despite this lack of approval, information from recent clinical trials have consistently suggested the widespread use of nitrates in the treatment of patients with CHF. [3][4][5] The purpose of the present study was to evaluate the attitudes of physician members of the Heart Failure Society of America regarding the use of nitrates in the management of chronic CHF in the United States.…”

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confidence: 99%

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Lancellotti¹,

Mélon²,

Sakalihasan

et al. 2004

The American Journal of Cardiology

102

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C ardiac resynchronization therapy (CRT) with biventricular pacing has emerged as a new approach for treating patients with heart failure and significant ventricular conduction delay and/or dyssynchrony. 1-3 CRT improves left ventricular systolic and diastolic function 4 and clinical status 5 and reduces functional mitral regurgitation (MR). 6 Whether CRT significantly affects exercise-induced changes in MR has never been investigated. This study examined the effects of CRT on MR and assessed the determinants of exercise-induced changes in MR under biventricular pacing.• • • This prospective study included 27 consecutive patients with heart failure who were clinically helped by biventricular pacing. Before CRT implantation, all were in New York Heart Association class III and had left ventricular ejection fractions Յ35%, functional MR, were in sinus rhythm, had QRS duration Ն140 ms, and had interventricular delay (the time interval between aortic and pulmonary valve opening) Ն50 ms. All patients underwent quantitative exercise Doppler echocardiography with and without active CRT. The causes of heart failure were idiopathic dilated cardiomyopathy in 9 patients and ischemic heart disease in 18. The protocol was approved by the human ethical committee of our university hospital, and all patients gave informed consent.A symptom-limited graded bicycle exercise test was performed in a semisupine position on a tilting exercise table. After an initial workload of 25 W maintained for 2 minutes, the workload was increased every 2 minutes by 25 W. Blood pressure and 12-lead electrocardiograms were recorded every 2 minutes. Two-dimensional and Doppler echocardiographic recordings were available throughout the test.Baseline and exercise echocardiographic studies were performed 45 Ϯ 16 days after implantation of the CRT system using the phased-array Acuson Sequoia (Siemens AG, Munich, Germany) or VIVID 7 (GE Healthcare, Little Chalfont, United Kingdom) imaging device. In 17 patients, after data acquisition during active CRT (CRT on), pacing was interrupted during 30 minutes before data acquisition during intrinsic conduction (CRT off). In the other 10 patients, data were first acquired with CRT off. All echocardiographic and Doppler recordings were obtained in digital format and stored on optical discs for off-line analysis. For each measurement, Ն3 cardiac cycles were averaged. The quantitation of MR was performed by the quantitative Doppler method using mitral and aortic stroke volumes and the proximal isovelocity surface area method, as previously described. 7,8 The results of these 2 methods were averaged, allowing the calculation of regurgitant volume and the effective regurgitant orifice (ERO). Left ventricular end-diastolic and end-systolic volumes and ejection fractions were measured by the bi-apical Simpson disk method. The left ventricular dP/dt was estimated from the steepest increasing segment of the continuous-

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“…On the clinical side, several trials have documented both increased functional capacity, as evaluated by means of the 6-minute walking test and the VO2 peak, and improvements in quality of life and New York Heart Association (NYHA) class [15][16][17][18][19][20][21][22][23]. Moreover, CRT has been seen to reduce HF hospitalizations and mortality by 36% [22], and the total number of days of hospitalization by 77% [17].…”

Section: Resultsmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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Heart Failure is the result of heterogeneous structural heart diseases, especially ischemic disease, and is becoming increasingly common in all Western countries.Many patients continue to be symptomatic in spite of progress in pharmacological therapy, and the risk of mortality remains high in the most advanced functional classes. Cardiac resynchronization therapy can be used as a therapeutic strategy for alleviating symptoms and reducing mortality in selected patients with heart failure.Cardiac resynchronization therapy provides both immediate and medium/long-term results. The immediate results are the reduced QRS duration, the synchrony restoration between the ventricles and between the lateral and septal walls of the left ventricle, the reduced mitral regurgitation and the increased stroke volume. In the medium/long term, left ventricular reverse remodeling occurs and left ventricular ejection fraction is increased.Several trials have documented both increased functional capacity and improvements in quality of life and New York Heart Association class. Moreover, cardiac resynchronization therapy has been seen to reduce HF hospitalizations and mortality and the total number of days of hospitalization.In order to reduce the percentage of non-responders to cardiac resynchronization therapy, it is necessary to optimize the prognostic stratification of candidates for implantation through multi-parameter evaluations and to ensure correct device programming with periodic updates which are widely recommended but not so often performed.Whether indications should be extended will need to be evaluated in view of the known complications mainly associated with lead implantation. RationaleIt is well known that QRS duration is inversely correlated with survival in HF patients in functional classes II-IV, and patients with QRS ≥200 ms have a 5-fold higher risk of death than those with a narrow QRS [7]. In particular, left bundle branch block (LBBB) usually delays activation of the posterior/lateral wall of the left ventricle, leading to asynchronous contraction between the septum and posterior-lateral wall and reducing the left ventricular ejection fraction (LVEF).CRT can correct this asynchronous contraction through the preexcitation of the posterior-lateral wall of the left ventricle, thereby improving systolic function [8,9]. Indeed, the dyssynchrony due to prolonged QRS duration involves the heterogeneous propagation of electrical activity in the ventricle, which determines various degrees of impaired coordination in filling and contraction [10]. Consequently the contractile efficiency of the heart is compromised and the myocardial oxygen consumption increases, worsening the clinical course of HF.

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long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay

Abstract: Cardiac resynchronization therapy produces a long-term improvement in the clinical symptoms of patients with HF who have a ventricular conduction delay. The differences between optimized biventricular and univentricular therapy appear to be small for short-term treatment.

Cited by 891 publications

References 26 publications

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

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