151. Cardiac resynchronization therapy by multipoint pacing improves response of left ventricular mechanics and fluid dynamics: A three-dimensional and particle image velocimetry echo study
- Author
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Stefano Cavedon, Domenico Corrado, Gianni Pedrizzetti, Federico Migliore, Luigi P. Badano, Emanuele Bertaglia, Denisa Muraru, Sabino Iliceto, Alessandro Zorzi, Mariachiara Siciliano, Siciliano, M, Migliore, F, Badano, L, Bertaglia, E, Pedrizzetti, G, Cavedon, S, Zorzi, A, Corrado, D, Iliceto, S, Muraru, D, Siciliano, Mariachiara, Migliore, Federico, Badano, Luigi, Bertaglia, Emanuele, Pedrizzetti, Gianni, Cavedon, Stefano, Zorzi, Alessandro, Corrado, Domenico, Iliceto, Sabino, and Muraru, Denisa
- Subjects
Male ,Patient-Specific Modeling ,Cardiac output ,Time Factors ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,Hemodynamics ,Predictive Value of Test ,030204 cardiovascular system & hematology ,Multipoint pacing ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,Cardiac resynchronization therapy ,Ejection fraction ,Models, Cardiovascular ,Cardiac fluid mechanic ,Hydrodynamic ,Middle Aged ,Biomechanical Phenomena ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Human ,Preliminary Data ,medicine.medical_specialty ,Time Factor ,Diastole ,Heart failure ,Cardiac Resynchronization Therapy Device ,03 medical and health sciences ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Image Interpretation, Computer-Assisted ,Cardiac fluid mechanics ,Humans ,Cardiac Resynchronization Therapy Devices ,Systole ,Aged ,Echocardiography, Doppler, Pulsed ,3D echocardiography ,business.industry ,Stroke Volume ,Blood flow ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,medicine.disease ,Particle image velocimetry ,Myocardial Contraction ,Hydrodynamics ,business - Abstract
Conventional biventricular pacing (BiV) involves pacing from the right ventricle (RV), and the left ventricle (LV) usually using a single bipolar lead at one site via the coronary sinus (CS), with the aimto restore electrical and mechanical synchrony in heart failure (HF) patients.1 However, one-third of patients fail to clinically respond to cardiac resyncronization therapy (CRT), which may be partially due to a suboptimal location of the LV lead position with persistent LV dyssynchrony.2 In search for improvements in CRT, several authors have proposed a multisite LV stimulation using multiple leads in different branches of the CS.3 However, this technique is associated with increased procedure duration, fluoroscopy exposure, and potential complications. A new approach that involves a multisite pacing performed within a single CS branch by using a single quadripolar lead (multipoint pacing, or MPP; St. Jude Medical, Sylmar, CA) has been suggested recently. Benefits in acute haemodynamics using pressure-volume loop analysis and LV dyssynchrony using two dimensional echocardiographic (2DE) have been demonstrated with MPP in comparison with BiV.4-7 Nevertheless, the effects of MPP on LV dyssynchrony using three-dimensional echocardiography (3DE) and on diastolic filling have not been established yet. Echocardiographic particle imaging velocimetry (Echo-PIV) is an emerging imaging technique, which allows intraventricular fluid dynamics blood assessment and characterization of diastolic vortex formation that may play a key role in LV filling efficiency.8-12 Recent fluid dynamics data demonstrated that in normal LV, the blood flow is characterized by a longitudinal alignment along the base-apex direction of the intraventricular hemodynamic fluid dynamics in compliance with the empting-filling process.12 Conversely, HF patients show an irregular vortex formation with local stagnation resulting in transversal forces and loss of the physiological longitudinal orientation of the intraventricular velocites.8-12 Changes in intraventricular flow dynamics by CRT are supposed to result in a longitudinal alignment restoration of LV intraventricular velocities.12 Accordingly, the aim of the present studywas to characterize the effect of MPP compared to BiV on: (i) LV geometry and function assessed by conventional 2DE and 3DE and (ii) LV flow dynamics assessed by Echo- PIV.
- Published
- 2017