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Index of contractile asymmetry improves patient selection for CRT: a proof-of-concept study

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Zaremba, Tomas ; Tayal, Bhupendar ; Riahi, Sam ; Thøgersen, Anna Margrethe ; Bruun, Niels Eske ; Emerek, Kasper Janus Grønn ; Kisslo, Joseph ; Hansen, Thomas Fritz ; Risum, Niels ; Søgaard, Peter. / Index of contractile asymmetry improves patient selection for CRT : a proof-of-concept study. I: Cardiovascular Ultrasound. 2019 ; Bind 17, Nr. 1. s. 19.

Bibtex

@article{26faa870caee40aa89c5d8eb7526447a,
title = "Index of contractile asymmetry improves patient selection for CRT: a proof-of-concept study",
abstract = "BACKGROUND: Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF.METHODS: Patients with HF and LBBB undergoing CRT (n = 89, 37.1{\%} females, 68 ± 9 years, ischemic etiology in 61{\%}, LV ejection fraction 27.1 ± 7.1{\%}) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15{\%} after 6 months was considered as positive response to CRT.RESULTS: CRT response was found in 66 (74.2{\%}) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT.CONCLUSIONS: Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.",
author = "Tomas Zaremba and Bhupendar Tayal and Sam Riahi and Th{\o}gersen, {Anna Margrethe} and Bruun, {Niels Eske} and Emerek, {Kasper Janus Gr{\o}nn} and Joseph Kisslo and Hansen, {Thomas Fritz} and Niels Risum and Peter S{\o}gaard",
year = "2019",
month = "10",
day = "10",
doi = "10.1186/s12947-019-0170-2",
language = "English",
volume = "17",
pages = "19",
journal = "Cardiovascular Ultrasound",
issn = "1476-7120",
publisher = "BioMed Central Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - Index of contractile asymmetry improves patient selection for CRT

T2 - a proof-of-concept study

AU - Zaremba, Tomas

AU - Tayal, Bhupendar

AU - Riahi, Sam

AU - Thøgersen, Anna Margrethe

AU - Bruun, Niels Eske

AU - Emerek, Kasper Janus Grønn

AU - Kisslo, Joseph

AU - Hansen, Thomas Fritz

AU - Risum, Niels

AU - Søgaard, Peter

PY - 2019/10/10

Y1 - 2019/10/10

N2 - BACKGROUND: Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF.METHODS: Patients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT.RESULTS: CRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT.CONCLUSIONS: Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.

AB - BACKGROUND: Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF.METHODS: Patients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT.RESULTS: CRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT.CONCLUSIONS: Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.

U2 - 10.1186/s12947-019-0170-2

DO - 10.1186/s12947-019-0170-2

M3 - Journal article

VL - 17

SP - 19

JO - Cardiovascular Ultrasound

JF - Cardiovascular Ultrasound

SN - 1476-7120

IS - 1

ER -

ID: 59170229