Timing of myocardial shortening determines left ventricular regional myocardial work and regional remodelling in hearts with conduction delays

Cvijić, Marta; Duchenne, Jürgen; Ünlü, Serkan; Michalski, Błażej; Aarones, Marit; Winter, Stefan; Aakhus, Svend; Fehske, Wolfgang; Stanković, Ivan; Voigt, Jens‐Uwe

doi:10.1093/ehjci/jex325

Cited by 37 publications

(30 citation statements)

References 22 publications

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“…Additionally, pre-CRT echocardiography was used to calculate segmental myocardial work, using an 18 segment model and a method, previously described by our group [9]. In short, a dedicated, MATLAB-based (version 2017b, The MathWorks, Inc., Natick, MA, USA) research software (TVA version 22.00, JU Voigt, Leuven) was used to determine LV pressure estimates according to the method described by Russell [10].…”

Section: Methodsmentioning

confidence: 99%

“…LV segmental mid-wall curvature was dynamically estimated from full trace export of the speckle tracking software and used together with the segmental wall thickness measurements to estimate segmental wall stress according to the formula of Laplace. Segmental stress-strain loops were generated, the area of which was considered to represent myocardial work per volume-unit [9]. Regional myocardial work in the septum and lateral wall was calculated as average of the stress-strain loop areas of the basal, mid, and apical segments of the respective wall.…”

Section: Methodsmentioning

confidence: 99%

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Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates

et al. 2019

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BackgroundIn order to better understand the concept of mechanical dyssynchrony, a promising hallmark of cardiac resynchronization therapy (CRT) response, we investigated its effect on regional myocardial metabolism and myocardial blood flow (MBF) in non-ischemic CRT candidates.ResultsThirty consecutive non-ischemic CRT eligible patients underwent static 18F-FDG and resting dynamic 13N-NH3 PET/CT. 18F-FDG uptake and MBF for septal and lateral wall were analysed and septal-to-lateral wall ratios (SLR) were calculated. Based on the presence of mechanical dyssynchrony (septal flash and/or apical rocking) on echocardiography, patients were divided into 2 groups, with (n = 23) and without (n = 7) mechanical dyssynchrony.Patients with mechanical dyssynchrony had significantly lower 18F-FDG SUVmean in the septum compared with the lateral wall (5.58 ± 2.65 vs 11.19 ± 4.10, p < 0.0001), while patients without mechanical dyssynchrony had a more homogeneous 18F-FDG distribution (7.33 ± 2.88 vs 8.31 ± 2.50, respectively, p = 0.30). Similarly, MBF was significantly different between the septal and lateral wall in the dyssynchrony group (0.57 ± 0.11 ml/g/min vs 0.92 ± 0.23 ml/g/min, respectively, p < 0.0001), whereas no difference was observed in the non-dyssynchrony group (0.61 ± 0.23 ml/g/min vs 0.77 ± 0.21 ml/g/min, respectively, p = 0.16). 18F-FDG SLR, but not MBF SLR, was associated with the presence of mechanical dyssynchrony and showed a significant inverse correlation with volumetric reverse remodeling after CRT (r = − 0.62, p = 0.001).ConclusionsNon-ischemic heart failure patients with mechanical dyssynchrony demonstrate heterogeneous regional metabolism and MBF compared with patients without dyssynchrony. However, only 18F-FDG SLR appeared to be highly associated with the presence of mechanical dyssynchrony.Trial registrationClinicaltrials, NCT02537782. Registered 2 September 2015.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates

et al. 2019

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“…A methodology for a completely non-invasive approach was proposed and validated against invasive measurements by Russell et al 10 . While the use of pressure as surrogate of wall stress assumes a homogeneous wall stress distribution, the differential thickening and thinning in the remodelled hearts can be compensated by the use of stress-strain-loops, where both regional wall thickness and mid-wall curvature are taken into account 11 . The resulting non-invasive regional stress-strain-loops thereby provide a measure of regional myocardial work per volume-unit.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously demonstrated long-term homogenisation of myocardial work distribution in patients with a clear volumetric response to cardiac resynchronisation therapy (CRT) 11 . We hypothesize that (I) the work is already re-distributed immediately after CRT-implantation, that (II) this re-distribution is the trigger for LV volumetric reverse-remodelling in these patients, and (III) that probably not all patients show the same level of work re-distribution.…”

Section: Introductionmentioning

confidence: 99%

Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling

Duchenne

Aalen

Cvijić

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling. Methods and results One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress–strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001). Conclusion The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT.

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“…1). Furthermore, regional strain patterns, particularly of septal strain, may help in assessing myocardial deformation in dyssynchronous HF, although the extent of acute change that predicts the clinical outcome remains unknown [24, 25]. …”

Section: Patterns Of Motion and Deformationmentioning

confidence: 99%

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

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Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.

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Timing of myocardial shortening determines left ventricular regional myocardial work and regional remodelling in hearts with conduction delays

Cited by 37 publications

References 22 publications

Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates

Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates

Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

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