Aims: Three distinct septal contraction patterns typical for left bundle branch block may be assessed using echocardiography in heart failure patients scheduled for cardiac resynchronization therapy (CRT). The aim of this study was to explore the association between these septal contraction patterns and the acute haemodynamic and electrical response to biventricular pacing (BIVP) in patients undergoing CRT implantation.
Methods And Results: Thirty-eight CRT candidates underwent speckle tracking echocardiography prior to device implantation. The patients were divided into two groups based on whether their septal contraction pattern was indicative of dyssynchrony (premature septal contraction followed by various amount of stretch) or not (normally timed septal contraction with minimal stretch). CRT implantation was performed under invasive left ventricular (LV) pressure monitoring and we defined acute CRT response as ≥10% increase in LV dP/dtmax. End-diastolic pressure (EDP) and QRS width served as a diastolic and electrical parameter, respectively. LV dP/dtmax improved under BIVP (737 ± 177 mmHg/s vs. 838 ± 199 mmHg/s, P < 0.001) and 26 patients (68%) were defined as acute CRT responders. Patients with premature septal contraction (n = 27) experienced acute improvement in systolic (ΔdP/dtmax: 18.3 ± 8.9%, P < 0.001), diastolic (ΔEDP: -30.6 ± 29.9%, P < 0.001) and electrical (ΔQRS width: -23.3 ± 13.2%, P < 0.001) parameters. No improvement under BIVP was observed in patients (n = 11) with normally timed septal contraction (ΔdP/dtmax: 4.0 ± 7.8%, P = 0.12; ΔEDP: -8.8 ± 38.4%, P = 0.47 and ΔQRS width: -0.9 ± 11.4%, P = 0.79).
Conclusion: Septal contraction patterns are an excellent predictor of acute CRT response. Only patients with premature septal contraction experienced acute systolic, diastolic, and electrical improvement under BIVP.
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http://dx.doi.org/10.1093/ehjci/jez315 | DOI Listing |
Med Eng Phys
December 2024
Cardiopulmonary Regenerative Engineering (CARE) Group, Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, UK; Lower Saxony Center for Biomedical Engineering, Implant Research and Development, Hannover Medical School, Germany. Electronic address:
In the past two decades there has been rapid development in the field of computational cardiac models. These have included either (i) mechanical models that assumed simultaneous myocardial activation, or (ii) electromechanical models that assumed time-varying myocardial activation. The influence of these modelling assumptions of myocardial activation on clinically relevant metrics, like myocardial strain, commonly used for validation of cardiac models has yet to be systematically examined, leading to uncertainty over their influence on the predictions of these models.
View Article and Find Full Text PDFCurr Cardiol Rep
December 2024
Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 1 Convention Avenue, Philadelphia, Pennsylvania, 19104, USA.
Am J Cardiol
November 2024
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut. Electronic address:
Artificial intelligence-enhanced electrocardiography (AI-ECG) can identify hypertrophic cardiomyopathy (HCM) on 12-lead ECGs and offers a novel way to monitor treatment response. Although the surgical or percutaneous reduction of the interventricular septum (SRT) represented initial HCM therapies, mavacamten offers an oral alternative. We aimed to assess the use of AI-ECG as a strategy to evaluate biologic responses to SRT and mavacamten.
View Article and Find Full Text PDFJ Cardiovasc Magn Reson
December 2024
Department of Cardiac Surgery, Chest Hospital, Tianjin University, Tianjin 300222, China; Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin 300222, China. Electronic address:
Background: Strain analysis offers a valuable tool to assess myocardial mechanics, allowing for the detection of impairments in heart function. This study aims to evaluate the pattern of myocardial strain in patients with heart failure (HF).
Methods: In the present study, myocardial strain was measured by cardiac magnetic resonance imaging feature tracking in 35 control subjects without HF and 195 HF patients.
J Echocardiogr
October 2024
Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium.
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