Tissue Doppler velocity is superior to strain imaging in predicting long-term cardiovascular events after cardiac resynchronisation therapy

Zhang, Q; Rj, van Bommel; Fung, John J.; Jy, Chan; Gb, Bleeker; Ypenburg, Claudia; Yip, Gabriel Wai-Kwok; Liang, Ye; Mj, Schalij; Jj, Bax; Yu, CM

doi:10.1136/hrt.2008.161653

Cited by 26 publications

(15 citation statements)

References 34 publications

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“…Parameters that have recently been studied to improve patient selection include QRS morphology in MADIT-CRT (left bundle branch block (LBBB), rather than non-LBBB, patterns appears to be the predominant morphology-that is, related to response), 100 baseline LV radial dyssynchrony, discordant LV lead position, and myocardial scar in the region of the LV pacing lead, 101 and prepacing systolic dyssynchrony measured by tissue Doppler imaging velocity. 102 Consistent with existing knowledge, LV lead positioning has been reconfirmed to be important in MADIT-CRT patients 103 and patients with non-ischaemic dilated cardiomyopathy. 104 The prospective, randomised SMART-AV (SmartDelay determined AV optimisation: a comparison with other AV delay methods used in CRT) study compared three different methods of AV optimisation (fixed empirical AV delay of 120 ms, echo-optimised AV delay, or AV optimisation with an ECG-based algorithm) in 980 patients with a CRT device to determine if any method was superior.…”

Section: Cardiac Resynchronisation Therapy and Pacingsupporting

confidence: 58%

Cardiac arrhythmias and pacing

Liew¹

2012

Srce i krvni sudovi

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Clinical trials i n the past 2 years, a number of landmark clinical trials have been published which further our understanding and clinical management of patients with atrial fibrillation (AF). Two of the major goals in the treatment of this condition include reducing progression or recurrence of the arrhythmia and decreasing the risk of cardiovascular events, thereby improving quality of life and decreasing morbidity. Following on from a large body of evidence from preclinical studies, small clinical trials and meta-analyses suggesting that blockade of the renin-angiotensin system has beneficial effects on the pathophysiology of AF, 1 two large multicentre, placebo-controlled, randomised trials were conducted to determine the effects of angiotensin II receptor blockers (ARBs) on AF.The first of these trials, published in 2009, tested the hypothesis that the ARB valsartan could reduce the recurrence of AF in patients with underlying cardiovascular disease, diabetes or left atrial enlargement and a history of documented AF, in addition to established treatments. 2A total of 1442 patients were enrolled into the study-722 assigned to the valsartan group (target dose 320 mg) and 720 to the placebo group. The investigators found that treatment with valsartan had no significant effect on AF recurrence (AF recurrence 51.4% in the valsartan group and 52.1% in the placebo group, p=0.73) over a relatively short follow-up period of 1 year.The second large ARB randomised controlled trial (RCT) published this year evaluated whether irbesartan would reduce the risk of cardiovascular events in patients with AF.3 Patients with a history of risk factors for stroke and a systolic blood pressure of at least 110 mm Hg were randomly assigned to receive either irbesartan (target dose of 300 mg once daily) or placebo. Patients for this study were already enrolled in one of two other AF trials looking at clopidogrel plus aspirin versus aspirin alone or versus oral anticoagulants. The investigators found that irbesartan did not reduce cardiovascular events or hospitalisation rates for AF (total of 9016 enrolled with a mean follow-up of 4.1 years) and that, not surprisingly, more patients in the irbesartan group had symptomatic hypotension and renal dysfunction than those in the placebo group.Although the main findings from both of these large RCTs were negative, it should be noted that they were secondary prevention studies-that is, patients already had established AF, and also had more advanced stages of disease (over 80% of patients in both studies had a history of persistent or permanent AF), implying that the substrate for AF was already well established in both study groups. It might be argued that blockade of the renin-angiotensin system may be a more effective strategy if performed earlier during the natural history of the disease or even before AF develops (ie, primary prevention), since ACE inhibitors and ARBs may prevent, but not necessarily reverse, the electrical and structural remodelling that leads to the development and p...

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Section: Cardiac Resynchronisation Therapy and Pacingsupporting

confidence: 58%

Cardiac arrhythmias and pacing

Liew¹

2012

Srce i krvni sudovi

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“…LV dyssynchrony at baseline was an independent determinant of cardiovascular mortality (hazard ratio 0.463, 95% confidence interval 0.720 to 0.972; Pϭ0.005). 36 Leyva et al 60 demonstrated the prognostic value of LV mechanical dyssynchrony assessed with MRI. In 148 heart failure patients, LV mechanical dyssynchrony was measured as the temporal dispersion of peak inward myocardial motion throughout the cardiac cycle.…”

Section: Mechanical Dyssynchrony and Crt: Focus On Predicting Longmentioning

confidence: 99%

“…The majority of the TDI-derived dyssynchrony indices are based on differences in time to onset or time to peak systolic velocity between 2, 4, or more opposing LV walls. 11,12,35,36 For example, the measurement of the maximum peak systolic velocity time delay between 4 opposing walls yielded a cutoff value of 65 ms to indicate the presence of significant LV dyssynchrony. 11 This TDI-derived LV dyssynchrony parameter yielded a sensitivity and specificity of 92% to predict significant LV reverse remodeling after CRT.…”

Section: Initial Echocardiographic Approaches To Predict Crt Responsementioning

confidence: 99%

Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Clinically Useful

Delgado

Bax

2011

Circulation

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T he beneficial effects of cardiac resynchronization therapy (CRT) on morbidity and mortality of heart failure patients with wide QRS complex have been demonstrated extensively. Various single-center and multicenter randomized, clinical trials have shown that CRT improves heart failure symptoms and left ventricular (LV) function and induces a significant reduction in LV volumes and mitral regurgitation. [1][2][3][4] In addition, CRT reduces the number of heart failure hospitalizations and improves long-term survival. [5][6][7][8] More important, unlike other heart failure medical therapies that may lose their effects over time, CRT is a long-term effective therapy. 9 Accordingly, current American Heart Association/American College of Cardiology/Heart and Rhythm Society guidelines consider CRT a class I indication for patients with drug-refractory heart failure symptoms, LV ejection fraction Ͻ35%, and wide QRS complex (Ͼ120 ms). 10 Response by Sung and Foster on p 655Despite these encouraging results, cumulative evidence shows that only 60% to 80% of patients exhibit a favorable clinical or echocardiographic response to CRT. 1 For example, in the MIRACLE (Multicenter InSync Randomized Clinical Evaluation) and the MIRACLE-ICD (Multicenter InSync Implantable Cardioverter Defibrillator) trials, more than 30% of the patients fulfilling the aforementioned inclusion criteria did not show a favorable clinical response to CRT. 5,8 Several single-center studies have reported similar nonresponse rates and have questioned the accuracy of these inclusion criteria to identify patients who will respond to CRT, which has encouraged the research of novel indices and strategies that can reliably predict response to CRT.One of these indices is LV mechanical dyssynchrony. In the last decade, multiple single-center trials and the Cardiac Resynchronization in Heart Failure (CARE-HF) trial have demonstrated that LV mechanical dyssynchrony indices (most of which are based on echocardiographic measures) have superior accuracy compared with LV electric dyssynchrony (based on QRS duration) to predict response to CRT and long-term outcome. 7,11-13 However, those results were challenged recently by the multicenter PROSPECT (Predictors of Response to CRT) trial, in which no single LV mechanical dyssynchrony parameter could accurately predict response to CRT. 14 In this controversy, we advocate the use of LV mechanical dyssynchrony as an additional selection criterion for CRT and address the strengths of current imaging modalities to evaluate LV mechanical dyssynchrony. In addition, the different pathophysiological factors that may determine CRT response will be discussed. Finally, the use of an integrated approach, including LV mechanical dyssynchrony, LV lead position, and extent of myocardial scar, will be proposed as a potential optimal strategy to evaluate candidates for CRT.

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“…Intraventricular dyssynchrony as evidenced by cardiac magnetic resonance also predicts mortality and morbidity after CRT 6. Furthermore, mechanical dyssynchrony, either independently or in combination with other clinical parameters, is associated with a superior survival outcome after CRT 8 9. Intuitively, therefore, the key benefit of CRT in restoring left ventricular synchrony should also extend to this group of narrow QRS patients, in an attempt to avert progressive dilation and electrical remodelling and possibly to translate into better long-term survival and a reduction in hospitalisations due to heart failure.…”

mentioning

confidence: 99%