Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy

Večeřa, Ján; Pěnička, Martin; Eriksen, Morten; Russell, Kristoffer; Bartunek, J.; Vanderheyden, Marc; Smiseth, Otto A.

doi:10.1093/ehjci/jew019

Cited by 106 publications

(80 citation statements)

References 12 publications

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“…STE has also been used for estimation of wasted work in patients with intraventricular conduction defect. 51 Wasted work specifically has been shown to be an important predictor of response to cardiac resynchronization therapy (CRT). 51 However, these newer applications of STE are currently in experimental stage only.…”

Section: Ste For Measurement Of Myocardial Workmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. evidence supporting the diagnosis of HF. Echocardiography is the most commonly used modality for this purpose because of its ease of application, noninvasive nature, safety, and ability to provide a vast amount of information about cardiac structure and function. Additionally, echocardiography also plays an important role in guiding therapeutic decision-making and in monitoring response to therapy. Over the past 3 decades, numerous advancements have occurred in the field of echocardiography that have helped improve our understanding of the morpho-functional aberrations occurring in HF. This review summarizes the recent advances in echocardiography as applicable to the evaluation and management of HF. Classification of Heart FailureTo facilitate clinical management, several attempts have been made to divide HF patients into categories that unify them according to their dominant clinical presentations. Thus, HF has often been described as low output failure or high output failure; forward failure or backward failure; systolic HF or diastolic HF; HFrEF or HF with preserved ejection fraction (HFpEF); and so on. More recently, HF has also been classified according to alterations in the mechanical function of the left ventricle (LV; Table 1). 6The classification of HF into systolic or diastolic HF appeared to be intuitive, categorizing patients based on the primary pathogenic abnormality, that is, impairment of cardiac contractility or impairment of filling. However, this description has now been abandoned with the recognition that these 2 entities are not mutually exclusive and have considerable overlap. Significant LV diastolic dysfunction is a ubiquitous occurrence in patients with systolic HF, whereas systolic dysfunction...

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Section: Ste For Measurement Of Myocardial Workmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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“…Recent studies focused on mechanical dyssynchrony by taking into account the wasted and constructive myocardial work by means of strain analyses and hemodynamic data [72, 73]. The assessment of regional distribution to myocardial work based on different hemodynamics patterns can be used to determine the impact of elevated load on myocardial performance in HF patients that qualify for CRT [74].…”

Section: Mechanical Workmentioning

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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“…Any difference is likely due to differing pacing locations as hearts had no underlying structural abnormalities. LVTAT 28 [17,30] 34 [25,40] 43 [39,60] 48 [41,52] 46 [40,53] SD-LVAT 6 [6,7] 8 [7,9] 12 [10,18] 13 [12,15] 12 [11,15] LV-RS 25 [21,32] 47 [41,53] 61 [45,68] 47 [37,48] 45 [42,48] SD-RS 8 [8,10] 15 [11,23] 16 [14,21] 22 [17,23] 15 [13,16]…”

Section: Resultsmentioning

confidence: 99%

“…The time derivative of L si depends linearly on the length of the series elastic element, mimicking the Frank-Starling mechanism 48 and equals zero during isometric contraction. The time derivative of C sarc,i, j depends on time (t), L si , and C sarc,i, j .…”

Section: Triseg and Contraction Model In Circadaptmentioning

confidence: 99%

“…Several imaging markers related to the motion or deformation of the septum, such as septal flash 44 , apical rocking, septal systolic rebound stretch (SRS SEPT ) [45][46][47] and wasted septal work 48,49 have been shown to be associated with both acute response to and clinical outcome after CRT. It is therefore important to understand the mechanisms underlying abnormal septal mechanical behavior in patients.…”

Section: Septal Mechanics As a Tool To Select Crt Candidatesmentioning

confidence: 99%

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Pacing the heart

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Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy

Cited by 106 publications

References 12 publications

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

Pacing the heart

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