| Comparative mechanical activation mapping of RV pacing to LBBB by 2D and 3D speckle tracking and association with response to resynchronization therapy. | |
| | |
MedLine Citation:
|
PMID: 20466341 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: The goals of this study were to compare patterns of mechanical activation in patients with chronic right ventricular (RV) pacing with those with left bundle branch block (LBBB) using 2-dimensional and novel 3-dimensional speckle tracking, and to compare ejection fraction (EF) response and long-term survival after cardiac resynchronization therapy (CRT). BACKGROUND: Several randomized CRT trials have excluded patients with chronic RV pacing, and current guidelines for CRT include patients with intrinsically widened QRS, typically LBBB. METHODS: We studied 308 patients who were referred for CRT: 227 had LBBB, 81 were RV paced. Dyssynchrony was assessed by tissue Doppler, routine pulsed Doppler, and 2-dimensional speckle-tracking radial strain. 3D strain was assessed using speckle tracking from a pyramidal dataset in a subset of 57 patients for mechanical activation mapping. Survival after CRT was compared with survival in a group of 46 patients with attempted, but failed, CRT. RESULTS: Patients with chronic RV pacing and LBBB had similar intraventricular dyssynchrony, with opposing wall delays by tissue Doppler of 82 +/- 45 ms versus 87 +/- 63 ms and anteroseptum-to-posterior delays by speckle tracking of 225 +/- 142 ms, versus 211 +/- 107 ms, respectively. RV-paced patients, however, had greater interventricular dyssynchrony: 44 +/- 24 ms versus 35 +/- 21 ms (p < 0.01), which correlated with their greater QRS duration (p < 0.001). Sites of latest mechanical activation were most often posterior or lateral in both groups, but RV-paced patients had sites of earliest activation more often from the inferior-septum and apex (p < 0.05). EF response was similar in RV-paced and LBBB groups, and survival free from transplantation or mechanical support after CRT was similarly favorable as compared with failed CRT patients over 5 years (p < 0.01). CONCLUSIONS: RV-paced patients, when compared with LBBB patients, had similar dyssynchronous patterns of mechanical activation and greater interventricular dyssynchrony. Importantly, RV-paced patients had similar EF response and long-term outcome as those with LBBB, which supports their candidacy for CRT. |
| | |
Authors:
|
Hidekazu Tanaka; Hideyuki Hara; Evan C Adelstein; David Schwartzman; Samir Saba; John Gorcsan |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
|
Title: JACC. Cardiovascular imaging Volume: 3 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2010 May |
Date Detail:
|
Created Date: 2010-05-14 Completed Date: 2010-08-30 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
|
Languages: eng Pagination: 461-71 Citation Subset: IM |
Copyright Information:
|
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
University of Pittsburgh, Pittsburgh, Pennsylvania, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Atrioventricular Block / mortality, physiopathology, therapy*, ultrasonography Bundle-Branch Block / mortality, physiopathology, therapy*, ultrasonography Cardiac Pacing, Artificial* Disease-Free Survival Echocardiography, Doppler* Echocardiography, Doppler, Pulsed Echocardiography, Three-Dimensional* Electric Countershock* Female Heart Failure / mortality, physiopathology, therapy*, ultrasonography Heart Ventricles / physiopathology, ultrasonography Humans Kaplan-Meiers Estimate Linear Models Male Middle Aged Patient Selection Predictive Value of Tests Stroke Volume Time Factors Treatment Outcome Ventricular Function, Left* |
| Grant Support | |
ID/Acronym/Agency:
|
2 K24 HL004503-06/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Echocardiographic dyssynchrony and health status outcomes from cardiac resynchronization therapy: in...
Next Document: Analysis of LV lead position in cardiac resynchronization therapy using different imaging modalities...