Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist

被引：61

作者：

Bertini, Matteo ^{[1
,2
]}

Marsan, Nina Ajmone ^{[1
]}

Delgado, Victoria ^{[1
]}

van Bommel, Rutger J. ^{[1
]}

Nucifora, Gaetano ^{[1
]}

Borleffs, C. Jan Willem ^{[1
]}

Boriani, Giuseppe ^{[2
]}

Biffi, Mauro ^{[2
]}

Holman, Eduard R. ^{[1
]}

van der Wall, Ernst E. ^{[1
,3
]}

Schalij, Martin J. ^{[1
]}

Bax, Jeroen J. ^{[1
]}

机构：

[1] Leiden Univ, Med Ctr, Dept Cardiol, NL-2333 ZA Leiden, Netherlands

[2] Univ Bologna, Dept Cardiol, Bologna, Italy

[3] Interuniv Cardiol Inst Netherlands Utrecht, Dept Cardiol, Utrecht, Netherlands

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2009年 / 54卷 / 14期

关键词：

heart failure; cardiac resynchronization therapy; left ventricular twist; left ventricular reverse remodeling; left ventricular lead position; CHRONIC HEART-FAILURE; SPECKLE TRACKING ECHOCARDIOGRAPHY; SYSTOLIC FUNCTION; APICAL ROTATION; RADIAL STRAIN; PACING SITE; QUANTIFICATION; DYSSYNCHRONY; RELAXATION; REVERSAL;

D O I：

10.1016/j.jacc.2009.05.063

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background LV twist is emerging as a comprehensive index of LV function. Methods Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero) lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume >= 15% at 6-month follow-up. A control group comprised 30 normal subjects. Results Peak LV twist in heart failure patients was 4.8 +/- 2.6 degrees compared with 15.0 +/- 3.6 degrees in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 +/- 2.4 degrees to 8.5 +/- 3.2 degrees (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 +/- 3.1 degrees to 8.6 +/- 3.0 degrees, p = 0.001) and midventricular (from 4.8 +/- 2.2 degrees to 6.4 +/- 3.9 degrees, p = 0.038) but not with a basal (5.0 +/- 3.3 degrees vs. 4.1 +/- 3.2 degrees, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 +/- 7% to 37 +/- 7%, p < 0.001) and midventricular (from 26 +/- 6% to 33 +/- 8%, p < 0.001) but not with a basal (26 +/- 5% vs. 28 +/- 8%, p = 0.30) LV lead position. Conclusions An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up. (J Am Coll Cardiol 2009; 54: 1317-25) (C) 2009 by the American College of Cardiology Foundation

引用

页码：1317 / 1325

页数：9

共 34 条

[1] Cardiac resynchronization in chronic heart failure [J].

Abraham, WT ;

Fisher, WG ;

Smith, AL ;

Delurgio, DB ;

Leon, AR ;

Loh, E ;

Kocovic, DZ ;

Packer, M ;

Clavell, AL ;

Hayes, DL ;

Ellestad, M ;

Messenger, J ;

Trupp, RJ ;

Underwood, J ;

Pickering, F ;

Truex, C ;

McAtee, P .

NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (24) :1845-1853

[2] Left ventricular lead performance in cardiac resynchronization therapy: Impact of lead localization and complications [J].

Albertsen, AE ;

Nielsen, JC ;

Pedersen, AK ;

Hansen, PS ;

Jensen, HK ;

Mortensen, PT .

PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2005, 28 (06) :483-488

[3]

Bogaert J, 2001, AM J PHYSIOL-HEART C, V280, pH610

[4] NONINVASIVE QUANTIFICATION OF LEFT-VENTRICULAR ROTATIONAL DEFORMATION IN NORMAL HUMANS USING MAGNETIC-RESONANCE-IMAGING MYOCARDIAL TAGGING [J].

BUCHALTER, MB ;

WEISS, JL ;

ROGERS, WJ ;

ZERHOUNI, EA ;

WEISFELDT, ML ;

BEYAR, R ;

SHAPIRO, EP .

CIRCULATION, 1990, 81 (04) :1236-1244

[5] Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients [J].

Butter, C ;

Auricchio, A ;

Stellbrink, C ;

Fleck, E ;

Ding, J ;

Yu, YH ;

Huvelle, E ;

Spinelli, J .

CIRCULATION, 2001, 104 (25) :3026-3029

[6] Results of the predictors of response to CRT (PROSPECT) trial [J].

Chung, Eugene S. ;

Leon, Angel R. ;

Tavazzi, Luigi ;

Sun, Jing-Ping ;

Nihoyannopoulos, Petros ;

Merlino, John ;

Abraham, William T. ;

Ghio, Stefano ;

Leclercq, Christophe ;

Bax, Jeroen J. ;

Yu, Cheuk-Man ;

Gorcsan, John, III ;

Sutton, Martin St John ;

De Sutter, Johan ;

Murillo, Jaime .

CIRCULATION, 2008, 117 (20) :2608-2616

[7] The effect of cardiac resynchronization on morbidity and mortality in heart failure [J].

Cleland, JGF ;

Daubert, J ;

Erdmann, E ;

Freemantle, N ;

Gras, D ;

Kappenberger, L ;

Tavazzi, L ;

Cleland, JGF ;

Daubert, JC ;

Erdmann, E ;

Gras, D ;

Kappenberger, L ;

Klein, W ;

Tavazzi, L ;

Poole-Wilson, PA ;

Rydén, L ;

Wedel, H ;

Wellens, HJJ ;

Uretsky, B ;

Thygesen, K ;

Böcker, D ;

Marijianowski, MMH ;

Freemantle, N ;

Calvert, MJ ;

Christ, G ;

Fruhwald, F ;

Hofmann, R ;

Krypta, A ;

Leisch, F ;

Pacher, R ;

Rauscha, F ;

Tavernier, R ;

Thomsen, PEB ;

Boesgaard, S ;

Eiskjær, H ;

Esperen, GT ;

Haarbo, J ;

Hagemann, A ;

Korup, E ;

Moller, M ;

Mortensen, P ;

Sogaard, P ;

Vesterlund, T ;

Huikuri, H ;

Niemelä, KI ;

Toivonen, L ;

Bauer, F ;

Cohen-Solal, A ;

Crocq, C ;

Djiane, P .

NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (15) :1539-1549

[8] Assessment of left ventricular dyssynchrony by speckle tracking strain imaging - Comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy [J].

Delgado, Victoria ;

Ypenburg, Claudia ;

van Bommel, Rutger J. ;

Tops, Laurens F. ;

Mollema, Sjoerd A. ;

Marsan, Nina Ajmone ;

Bleeker, Gabe B. ;

Schalij, Martin J. ;

Bax, Jeroen J. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 51 (20) :1944-1952

[9] Cardiac rotation and relaxation in patients with chronic heart failure [J].

Fuchs, E ;

Müller, MF ;

Oswald, H ;

Thöny, H ;

Mohacsi, P ;

Hess, OM .

EUROPEAN JOURNAL OF HEART FAILURE, 2004, 6 (06) :715-722

[10]

GREENBAUM RA, 1981, BRIT HEART J, V45, P248

← 1 2 3 4 →