Document Detail

Septal deformation patterns delineate mechanical dyssynchrony and regional differences in contractility: analysis of patient data using a computer model.
MedLine Citation:
PMID:  21980078     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Response to cardiac resynchronization therapy depends both on dyssynchrony and (regional) contractility. We hypothesized that septal deformation can be used to infer integrated information on dyssynchrony and regional contractility, and thereby predict cardiac resynchronization therapy response.
METHODS AND RESULTS: In 132 cardiac resynchronization therapy candidates with left bundle branch block (LBBB)-like electrocardiogram morphology (left ventricular ejection fraction 19±6%; QRS width 170±23 ms), longitudinal septal strain was assessed by speckle tracking echocardiography. To investigate the effects of dyssynchronous activation and differences in septal and left ventricular free wall contractility on septal deformation pattern, we used the CircAdapt computer model of the human heart and circulation. In the patients, 3 characteristic septal deformation patterns were identified: LBBB-1=double-peaked systolic shortening (n=28); LBBB-2=early systolic shortening followed by prominent systolic stretching (n=34); and LBBB-3=pseudonormal shortening with less pronounced late systolic stretch (n=70). LBBB-3 revealed more scar (2 [2-5] segments) compared with LBBB-1 and LBBB-2 (both 0 [0-1], P<0.05). In the model, imposing a time difference of activation between septum and left ventricular free wall resulted in pattern LBBB-1. This transformed into pattern LBBB-2 by additionally simulating septal hypocontractility, and into pattern LBBB-3 by imposing additional left ventricular free wall or global left ventricular hypocontractility. Improvement of left ventricular ejection fraction and reduction of left ventricular volumes after cardiac resynchronization therapy were most pronounced in LBBB-1 and worst in LBBB-3 patients.
CONCLUSIONS: A double-peaked systolic septal deformation pattern is characteristic for LBBB and results from intraventricular dyssynchrony. Abnormal contractility modifies this pattern. A computer model can be helpful in understanding septal deformation and predicting cardiac resynchronization therapy response.
Geert E Leenders; Joost Lumens; Maarten J Cramer; Bart W L De Boeck; Pieter A Doevendans; Tammo Delhaas; Frits W Prinzen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-06
Journal Detail:
Title:  Circulation. Heart failure     Volume:  5     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-18     Completed Date:  2012-04-13     Revised Date:  2012-05-24    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  87-96     Citation Subset:  IM    
Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
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MeSH Terms
Blood Circulation / physiology
Bundle-Branch Block / physiopathology*,  therapy,  ultrasonography*
Cardiac Resynchronization Therapy
Cohort Studies
Computer Simulation*
Heart Ventricles / physiopathology*,  ultrasonography*
Middle Aged
Myocardial Contraction / physiology*
Predictive Value of Tests
Retrospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology,  ultrasonography
Ventricular Septum / physiopathology*,  ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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