Slow Wall Motion Rather Than Electrical Conduction Delay Underlies Mechanical Dyssynchrony in Postinfarction Patients With Narrow QRS Complex

Klemm, Hanno; Krause, Korff; Ventura, Rodolfo; Schneider, Carsten; Aydin, Muhammat A.; Johnsen, Christin; Boczor, Sigrid; Meinertz, Thomas; Morillo, Carlos A.; Kuck, Karl‐Heinz

doi:10.1111/j.1540-8167.2009.01579.x

Cited by 14 publications

(11 citation statements)

References 31 publications

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“…Regional contractility and conduction velocity were lowest in MI segments and intermediate in peri-MI segments, unlike the study by Klemm et al [30] in patients with ischemic cardiomyopathy, which found viability and increased CV in areas with slow wall motion. We did not find mechanical delays in the peri-MI zones despite reduced regional function at 1 week post MI.…”

Section: Discussioncontrasting

confidence: 86%

Assessment of distribution and evolution of Mechanical dyssynchrony in a porcine model of myocardial infarction by cardiovascular magnetic resonance

Abd‐Elmoniem

Tomas

Sasano

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundWe sought to investigate the relationship between infarct and dyssynchrony post- myocardial infarct (MI), in a porcine model. Mechanical dyssynchrony post-MI is associated with left ventricular (LV) remodeling and increased mortality.MethodsCine, gadolinium-contrast, and tagged cardiovascular magnetic resonance (CMR) were performed pre-MI, 9 ± 2 days (early post-MI), and 33 ± 10 days (late post-MI) post-MI in 6 pigs to characterize cardiac morphology, location and extent of MI, and regional mechanics. LV mechanics were assessed by circumferential strain (eC). Electro-anatomic mapping (EAM) was performed within 24 hrs of CMR and prior to sacrifice.ResultsMean infarct size was 21 ± 4% of LV volume with evidence of post-MI remodeling. Global eC significantly decreased post MI (-27 ± 1.6% vs. -18 ± 2.5% (early) and -17 ± 2.7% (late), p < 0.0001) with no significant change in peri-MI and MI segments between early and late time-points. Time to peak strain (TTP) was significantly longer in MI, compared to normal and peri-MI segments, both early (440 ± 40 ms vs. 329 ± 40 ms and 332 ± 36 ms, respectively; p = 0.0002) and late post-MI (442 ± 63 ms vs. 321 ± 40 ms and 355 ± 61 ms, respectively; p = 0.012). The standard deviation of TTP in 16 segments (SD16) significantly increased post-MI: 28 ± 7 ms to 50 ± 10 ms (early, p = 0.012) to 54 ± 19 ms (late, p = 0.004), with no change between early and late post-MI time-points (p = 0.56). TTP was not related to reduction of segmental contractility. EAM revealed late electrical activation and greatly diminished conduction velocity in the infarct (5.7 ± 2.4 cm/s), when compared to peri-infarct (18.7 ± 10.3 cm/s) and remote myocardium (39 ± 20.5 cm/s).ConclusionsMechanical dyssynchrony occurs early after MI and is the result of delayed electrical and mechanical activation in the infarct.

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Section: Discussioncontrasting

confidence: 86%

Assessment of distribution and evolution of Mechanical dyssynchrony in a porcine model of myocardial infarction by cardiovascular magnetic resonance

Abd‐Elmoniem

Tomas

Sasano

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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“…Therefore, an meta-analysis of individual data from patients treated with intramyocardial stem cell therapy has started and will be completed by the end of 2011. 98 Most NOGA ® -guided therapeutic studies targeted the injections either to the border zone of infarction (identi fied by decreased unipolar voltage and moderately decreased LLS), or areas of chronic ischemia (identified by normal or decreased unipolar voltage and moderately to severely decreased LLS). The site of the intramyocardial injections is selected mainly on the basis of the NOGA ® unipolar voltage and LLS maps, relying on their diagnostic and prognostic values and their excellent correlation with ischemia-related images obtained with noninvasive techniques.…”

Section: Functional Recovery After Pcimentioning

confidence: 99%

Diagnostic and prognostic value of 3D NOGA mapping in ischemic heart disease

Gyöngyösi

Dib

2011

Nat Rev Cardiol

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The three-dimensional NOGA(®) (Biologics Delivery Systems, a Johnson & Johnson company, Irwindale, CA, USA) electromechanical mapping system simultaneously registers the electrical and mechanical activities of the left ventricle, enabling online assessment of myocardial viability. The system distinguishes between viable, nonviable, stunned, and hibernating myocardium and can assess wall motion. The evaluation of the electrophysiological state of the tissue by NOGA(®) mapping has been validated by comparing the electroanatomical voltage and local linear shortening maps obtained with this technique with several noninvasive diagnostic tests. Bipolar signal analysis and determination of the existence and degree of transmural infarctions are also possible with NOGA(®). Immediately after percutaneous coronary intervention, an increased electromechanical discordance between voltage and local linear shortening maps indicates procedure-induced stunning that is caused by repetitive ischemia or microvascular compromise. Catheter-based direct intramyocardial injection of cells or gene constructs by NOGA(®) reduces the likelihood of systemic toxicity of the injected substance, resulting in minimal washout, limited exposure of nontarget organs, and precise localization to ischemic and peri-ischemic myocardial regions in patients with chronic myocardial ischemia. In addition, direct intramyocardial injection enables the treatment of chronic myocardial infarction by provoking a chemotactic signal at the injection-injury site that contributes to cell engraftment. By measuring the electrical activation pattern in delayed-motion areas, NOGA(®) might also be useful to predict response to cardiac resynchronization therapy.

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“…The larger EMD is a result of the increased force required to generate shortening within the late activated region [15]. Interestingly, there can even be a mechanical delay without any evidence of electrical activation delay [17]. Most of these studies, however, have been conducted in canine models of LBBB and it is uncertain how this relationship manifests in patients undergoing CRT.…”

Section: Introductionmentioning

confidence: 99%

Relationship between mechanical dyssynchrony and intra-operative electrical delay times in patients undergoing cardiac resynchronization therapy

Suever

Hartlage

Magrath

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundIt is important to understand the relationship between electrical and mechanical ventricular activation in CRT patients. By measuring local electrical activation at multiple locations within the coronary veins and myocardial contraction at the same locations in the left ventricle, we determined the relationship between electrical and mechanical activation at potential left ventricular pacing locations.MethodsIn this study, mechanical contraction times were computed using high temporal resolution cine cardiovascular magnetic resonance (CMR) data, while electrical activation times were derived from intra-procedural local electrograms.ResultsIn our cohort, there was a strong correlation between electrical and mechanical delay times within each patient (R2 = 0.78 ± 0.23). Additionally, the latest electrically activated location corresponded with the latest mechanically contracting location in 91% of patients.ConclusionsThis study provides initial evidence that our method of obtaining non-invasive mechanical activation patterns accurately reflects the underlying electromechanical substrate of intraventricular dyssynchrony.

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Slow Wall Motion Rather Than Electrical Conduction Delay Underlies Mechanical Dyssynchrony in Postinfarction Patients With Narrow QRS Complex

Abstract: Dyssynchronous segments of an ischemic myocardium show unimpaired local activation but slow wall motion, thereby limiting the benefit of ventricular preexcitation via CRT.

Cited by 14 publications

References 31 publications

Assessment of distribution and evolution of Mechanical dyssynchrony in a porcine model of myocardial infarction by cardiovascular magnetic resonance

Assessment of distribution and evolution of Mechanical dyssynchrony in a porcine model of myocardial infarction by cardiovascular magnetic resonance

Diagnostic and prognostic value of 3D NOGA mapping in ischemic heart disease

Relationship between mechanical dyssynchrony and intra-operative electrical delay times in patients undergoing cardiac resynchronization therapy

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