Jürgen Duchenne1,2, John M Aalen3,4,5, Marta Cvijic1,2,6, Camilla K Larsen3,4,5, Elena Galli7,8, Stéphanie Bézy1,2, Ahmed S Beela1,2,9, Serkan Ünlü1,2, Efstathios D Pagourelias1,2,10, Stefan Winter11, Einar Hopp12, Erik Kongsgård3,4, Erwan Donal7,8, Wolfgang Fehske11, Otto A Smiseth3,4,5, Jens-Uwe Voigt1,2. 1. Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium. 2. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. 3. Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway. 4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5. Department of Cardiology, Oslo University Hospital, Oslo, Norway. 6. Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia. 7. LTSI, Inserm 1099, University of Rennes, Rennes, France. 8. Department of Cardiology, CHU Rennes, France. 9. Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. 10. Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 11. Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany. 12. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Abstract
AIMS: Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling. METHODS AND RESULTS: One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress-strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001). CONCLUSION: The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling. METHODS AND RESULTS: One hundred and thirty heart failurepatients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress-strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001). CONCLUSION: The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT. Published on behalf of the European Society of Cardiology. All rights reserved.
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