Document Detail


Redistribution of left ventricular strain by cardiac resynchronization therapy in heart failure patients.
MedLine Citation:
PMID:  21106543     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The aim of this study was to investigate (i) the baseline patterns of segmental peak myocardial strain (PMS) in heart failure (HF) patients with ventricular conduction delay, (ii) changes in patterns of segmental PMS induced by cardiac resynchronization therapy (CRT), and (iii) whether they differ between CRT responders and non-responders.
METHODS AND RESULTS: Segmental and global longitudinal (L-) and radial (R-) PMS measurements derived from speckle tracking were prospectively obtained in 85 HF patients with intraventricular conduction delay before and 6 months after CRT device implantation and in 30 healthy subjects. Segmental strain analysis in HF patients showed pronounced heterogeneity both in longitudinal and in radial directions with the lowest amplitudes in the septum and the highest amplitudes in the lateral and posterior walls. After CRT, 60% of the patients were responders (≥ 15% reduction in end-systolic volume). Before CRT, responders showed higher global R-PMS than non-responders (19.5 ± 13.4 vs.13.1 ± 4.8%, respectively; P = 0.04) despite similar global L-PMS. After CRT, responders showed an increase in L-PMS in most segments and a homogeneous increase in R-PMS, leading to a more uniform pattern of strain and an improved global L-PMS and R-PMS. In contrast, in non-responders, the gain in L-PMS and R-PMS in septal segments was completely offset by a decrease in posterolateral segments, failing to decrease segmental heterogeneity and to increase global L-PMS and R-PMS.
CONCLUSION: Heart failure patients with ventricular conduction delay show pronounced heterogeneous patterns of segmental PMS, which can be reversed by CRT.
Authors:
Julija Klimusina; Bart W De Boeck; Geert E H Leenders; Francesco F Faletra; Frits Prinzen; Manuela Averaimo; Elena Pasotti; Catherine Klersy; Tiziano Moccetti; Angelo Auricchio
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-23
Journal Detail:
Title:  European journal of heart failure     Volume:  13     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-25     Completed Date:  2011-05-09     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  186-94     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial / methods*
Cardiac Resynchronization Therapy / methods
Case-Control Studies
Echocardiography, Doppler / methods*
Female
Heart Conduction System / physiopathology*
Heart Failure / mortality,  therapy*,  ultrasonography
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Myocardial Contraction / physiology
Prognosis
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Stress, Physiological / physiology*
Survival Analysis
Treatment Outcome
Ventricular Dysfunction, Left / mortality,  physiopathology,  therapy*,  ultrasonography
Ventricular Remodeling / physiology

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