BACKGROUND: Definition of the optimal left ventricular (LV) lead position in cardiac resynchronisation therapy (CRT) is desirable. OBJECTIVE: To define the optimal LV lead position in CRT and assess the effectiveness of CRT depending on the LV lead position using new myocardial deformation imaging. METHODS: Myocardial deformation imaging based on tracking of acoustic tissue pixels in two-dimensional echocardiographic images (EchoPAC, GE ultrasound) was performed in 47 patients with heart failure at baseline and during CRT. In a 36-segment LV model the segment with the latest peak systolic circumferential strain before CRT was determined. The segment with maximal temporal difference in peak systolic circumferential strain on CRT compared with before CRT was assumed to be the LV lead position. The optimal LV lead position was defined as concurrence or immediate neighbouring of the segment with the latest contraction before CRT and those with assumed LV lead location. RESULTS: 25 patients had optimal and 22 non-optimal LV lead positions. Before CRT, the LV ejection fraction (EF) and peak oxygen consumption (Vo2max) were similar in patients with optimal and non-optimal LV lead positions (mean (SD) EF = 31.4 (6.1)% vs 30.3 (6.5)% and Vo2max = 14.2 (1.8) vs 14.0 (2.1) ml/min/kg, respectively). At 3 months on CRT, EF increased by 9 (2)% vs 5 (3)% and Vo2max by 2.0 (0.8) vs 1.1 (0.5) ml/min/kg in the optimal vs non-optimal LV lead position groups, respectively (both p<0.001). CONCLUSIONS: Concordance of the LV lead site and location of the latest systolic contraction before CRT results in greater improvement in EF and cardiopulmonary workload than the non-optimal LV lead position.
BACKGROUND: Definition of the optimal left ventricular (LV) lead position in cardiac resynchronisation therapy (CRT) is desirable. OBJECTIVE: To define the optimal LV lead position in CRT and assess the effectiveness of CRT depending on the LV lead position using new myocardial deformation imaging. METHODS: Myocardial deformation imaging based on tracking of acoustic tissue pixels in two-dimensional echocardiographic images (EchoPAC, GE ultrasound) was performed in 47 patients with heart failure at baseline and during CRT. In a 36-segment LV model the segment with the latest peak systolic circumferential strain before CRT was determined. The segment with maximal temporal difference in peak systolic circumferential strain on CRT compared with before CRT was assumed to be the LV lead position. The optimal LV lead position was defined as concurrence or immediate neighbouring of the segment with the latest contraction before CRT and those with assumed LV lead location. RESULTS: 25 patients had optimal and 22 non-optimal LV lead positions. Before CRT, the LV ejection fraction (EF) and peak oxygen consumption (Vo2max) were similar in patients with optimal and non-optimal LV lead positions (mean (SD) EF = 31.4 (6.1)% vs 30.3 (6.5)% and Vo2max = 14.2 (1.8) vs 14.0 (2.1) ml/min/kg, respectively). At 3 months on CRT, EF increased by 9 (2)% vs 5 (3)% and Vo2max by 2.0 (0.8) vs 1.1 (0.5) ml/min/kg in the optimal vs non-optimal LV lead position groups, respectively (both p<0.001). CONCLUSIONS: Concordance of the LV lead site and location of the latest systolic contraction before CRT results in greater improvement in EF and cardiopulmonary workload than the non-optimal LV lead position.
Authors: C Leclercq; S Walker; C Linde; J Clementy; A J Marshall; P Ritter; P Djiane; P Mabo; T Levy; F Gadler; C Bailleul; J-C Daubert Journal: Eur Heart J Date: 2002-11 Impact factor: 29.983
Authors: William T Abraham; Westby G Fisher; Andrew L Smith; David B Delurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Milton Packer; Alfredo L Clavell; David L Hayes; Myrvin Ellestad; Robin J Trupp; Jackie Underwood; Faith Pickering; Cindy Truex; Peggy McAtee; John Messenger Journal: N Engl J Med Date: 2002-06-13 Impact factor: 91.245
Authors: Angelo Auricchio; Christoph Stellbrink; Stefan Sack; Michael Block; Jürgen Vogt; Patricia Bakker; Christof Huth; Friedrich Schöndube; Ulrich Wolfhard; Dirk Böcker; Olaf Krahnefeld; Hans Kirkels Journal: J Am Coll Cardiol Date: 2002-06-19 Impact factor: 24.094
Authors: Cheuk-Man Yu; Elaine Chau; John E Sanderson; Katherine Fan; Man-Oi Tang; Wing-Hong Fung; Hong Lin; Shun-Ling Kong; Yui-Ming Lam; Michael R S Hill; Chu-Pak Lau Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: S Cazeau; C Leclercq; T Lavergne; S Walker; C Varma; C Linde; S Garrigue; L Kappenberger; G A Haywood; M Santini; C Bailleul; J C Daubert Journal: N Engl J Med Date: 2001-03-22 Impact factor: 91.245
Authors: Maria Vittoria Pitzalis; Massimo Iacoviello; Roberta Romito; Francesco Massari; Brian Rizzon; Giovanni Luzzi; Pietro Guida; Andrea Andriani; Filippo Mastropasqua; Paolo Rizzon Journal: J Am Coll Cardiol Date: 2002-11-06 Impact factor: 24.094
Authors: Ole-A Breithardt; Christoph Stellbrink; Andreas Franke; Osman Balta; Björn H Diem; Patricia Bakker; Stefan Sack; Angelo Auricchio; Thierry Pochet; Rodney Salo Journal: Am Heart J Date: 2002-01 Impact factor: 4.749
Authors: Peter Søgaard; Henrik Egeblad; W Yong Kim; Henrik K Jensen; Anders K Pedersen; Bent Ø Kristensen; Peter T Mortensen Journal: J Am Coll Cardiol Date: 2002-08-21 Impact factor: 24.094