Significant increase of flow kinetic energy in “nonresponders” patients to cardiac resynchronization therapy

Abstract

Our data show a significant worsening in flow-derived parameters in CRT "nonresponders" patients as compared with responders. Further larger longitudinal studies are necessary to assess whether these more chaotic intraventricular flow-patterns may contribute to a persistent adverse remodeling observed in this subset of patients.

Changes in Intraventricular Flow Patterns after MitraClip Implant in Patients with Functional Severe Mitral Regurgitation

“…1 On the other hand, the COAPT trial found that among patients with moderateto-severe or severe MR who remain symptomatic despite optimal medical therapy, MitraClip (Abbott Vascular, Santa Clara, CA) implantation resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 2 years of follow-up compared with those referred to medical therapy alone. 2 In the last years, there has been an increasing interest in intraventricular (IV) fluid dynamics, assessed by Echo Particle Imaging Velocimetry (Echo-PIV), [3][4][5] and their epigenetic role in inducing changes in left ventricular (LV) dimensions and function in different clinical conditions. [3][4][5] Only a few computational studies have investigated the impact of the revised valve anatomy following MitraClip implantation on IV vortices formation.…”

“…2 In the last years, there has been an increasing interest in intraventricular (IV) fluid dynamics, assessed by Echo Particle Imaging Velocimetry (Echo-PIV), [3][4][5] and their epigenetic role in inducing changes in left ventricular (LV) dimensions and function in different clinical conditions. [3][4][5] Only a few computational studies have investigated the impact of the revised valve anatomy following MitraClip implantation on IV vortices formation. 5,6 Previous studies clearly showed that some parameters derived from IV flow analysis are closely associated with adverse LV remodeling.…”

“…5,6 Previous studies clearly showed that some parameters derived from IV flow analysis are closely associated with adverse LV remodeling. [3][4][5]7 We evaluated the in vivo effects of percutaneous mitral repair on LV intracavitary fluid dynamics in patients with secondary MR. To achieve this aim, 20 patients with dilated cardiomyopathy and symptomatic functional MR with clinical indication for MitraClip implantation were enrolled. All enrolled patients underwent transthoracic two-and threedimensional echocardiography before and after (2 6 1 days) the percutaneous mitral valve repair procedure.…”

“…Echo-PIV analysis has been described in detail and validated in previous studies. [3][4][5] Quantification of LV flow was performed by postprocessing analysis using a dedicated software (Hyperflow v.8.1.4.0, AMID, Italy), tracking contrast particle patterns in the LV frame by frame. For statistical processing, a set of scalar dimensionless parameters related to the flow pattern were defined.…”

Intracardiac flow analysis in cardiac resynchronization therapy: A new challenge?

“…Interpretation of these results was that electrical activation does not reflect in an immediate alteration of KE dissipation but, according with previous observations, modifications of energetic properties develop progressively during different stages of LV dysfunction. Subsequently, Cimino et al, using the same technique, repeated the evaluation performed by Pedrizzetti et al separately in responders and nonresponders to CRT. KE dissipation was expressed using the total energy dissipation index and the vorticity fluctuation index, two parameters describing energetic properties of flow.…”