Elena Galli1,2, Christophe Leclercq1,2, Arnaud Hubert1,2, Anne Bernard2,3, Otto A Smiseth4, Philippe Mabo1,2, Eigil Samset4, Alfredo Hernandez2, Erwan Donal1,2. 1. Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou - Rennes, 2 Rue Henri Le Guilloux, Rennes, France. 2. LTSI, Université de Rennes 1 - INSERM, UMR 1099 - Rennes, Rennes, France. 3. Service de Cardiologue, CHRU Tours, Tours, France. 4. Division Cardiovascular and Pulmonary Diseases, Institute for Surgical Research, Medical Faculty, Oslo Univeristy, Rickhospitalet, Oslo-Norway.
Abstract
Aims: Cardiac resynchronization therapy (CRT) plays a pivotal role in the management of patients with heart failure (HF) and wide QRS complex. However, the treatment is plagued by numerous non-responders. Aim of the study is to evaluate the role myocardial work estimated by pressure-strain loops (PSLs) in the comprehension of physiological mechanisms associated with CRT and in the prediction of CRT response. Methods and results: Ninety-seven patients with symptomatic HF (ejection fraction: 27 ± 6%, QRS duration 164 ± 18 ms) undergoing CRT implantation according to current recommendations were retrospectively included in the study. Standard 2D and speckle tracking echocardiography were performed before CRT and at the 6-month follow-up (FU). PSL analysis allowed the calculation of global and regional myocardial constructive work (CW) and wasted work (WW). A > 15% reduction in left ventricular (LV) end-systolic volume at FU defined CRT-positive response (CRT-PR). At FU, 63 (65%) patients responded to CRT. Global CW (CWtot) was significantly increased in CRT-responders. At multivariate analysis, CWtot > 1057 mmHg% (OR 14.69, P = 0.005) and septal flash (OR 8.05, P = 0.004) were the only significant predictors of CRT-PR. CWtot was associated with the entity of CRT-induced myocardial remodelling in both ischaemic (r = -0.55, P < 0.0001) and non-ischaemic patients (r = 0.65, P < 0.0001). A CWtot < 1057 mmHg% identified 85% of non-responders with a positive predictive value of 88%. Conclusion: Patients with higher CWtot exhibit a favourable response to CRT. These data encourage further studies for the assessment of the myocardial substrate related to the functional response to CRT.
Aims: Cardiac resynchronization therapy (CRT) plays a pivotal role in the management of patients with heart failure (HF) and wide QRS complex. However, the treatment is plagued by numerous non-responders. Aim of the study is to evaluate the role myocardial work estimated by pressure-strain loops (PSLs) in the comprehension of physiological mechanisms associated with CRT and in the prediction of CRT response. Methods and results: Ninety-seven patients with symptomatic HF (ejection fraction: 27 ± 6%, QRS duration 164 ± 18 ms) undergoing CRT implantation according to current recommendations were retrospectively included in the study. Standard 2D and speckle tracking echocardiography were performed before CRT and at the 6-month follow-up (FU). PSL analysis allowed the calculation of global and regional myocardial constructive work (CW) and wasted work (WW). A > 15% reduction in left ventricular (LV) end-systolic volume at FU defined CRT-positive response (CRT-PR). At FU, 63 (65%) patients responded to CRT. Global CW (CWtot) was significantly increased in CRT-responders. At multivariate analysis, CWtot > 1057 mmHg% (OR 14.69, P = 0.005) and septal flash (OR 8.05, P = 0.004) were the only significant predictors of CRT-PR. CWtot was associated with the entity of CRT-induced myocardial remodelling in both ischaemic (r = -0.55, P < 0.0001) and non-ischaemic patients (r = 0.65, P < 0.0001). A CWtot < 1057 mmHg% identified 85% of non-responders with a positive predictive value of 88%. Conclusion:Patients with higher CWtot exhibit a favourable response to CRT. These data encourage further studies for the assessment of the myocardial substrate related to the functional response to CRT.
Authors: Kimi P Owashi; Arnaud Hubert; Elena Galli; Erwan Donal; Alfredo I Hernández; Virginie Le Rolle Journal: PLoS One Date: 2020-03-03 Impact factor: 3.240
Authors: Thuy T M Pham; Vien T Truong; Phuc N Vu; Truong X Tran; Nam N H Nguyen; Linh P T Nguyen; Hien N T Tu; Cassady Palmer; Justin T Tretter; Philip Levy; Wojciech Mazur; Vinh N Pham Journal: Pediatr Cardiol Date: 2021-07-30 Impact factor: 1.655