1,250 results on '"Ventricular dyssynchrony"'
Search Results
302. P5742Electrical ventricular dyssynchrony by 12-lead ECG vs. mechanical activation of LV by STE
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Jaroslav Meluzín, Pavel Jurák, Magdalena Matejkova, Jolana Lipoldová, Josef Halamek, Miroslav Novák, and Pavel Leinveber
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medicine.medical_specialty ,business.industry ,Internal medicine ,12 lead ecg ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Ventricular dyssynchrony ,medicine.disease - Published
- 2018
303. P893Myocardial constructive work is additive to left ventricular dyssynchrony and volumetric response to CRT in the prediction of overall mortality after CRT implantation
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Arnaud Hubert, Christophe Leclercq, Erwan Donal, Alfredo Hernandez, Elena Galli, Otto A. Smiseth, and V Le Rolle
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medicine.medical_specialty ,business.industry ,Work (physics) ,030204 cardiovascular system & hematology ,medicine.disease ,Constructive ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Ventricular dyssynchrony ,business - Published
- 2018
304. Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions
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Judit Szilagyi, Christina Alhede, Jeffrey E. Olgin, Dolkun Rahmutula, Tomos E. Walters, Richard E. Sievers, Qizhi Fang, and Edward P. Gerstenfeld
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medicine.medical_specialty ,Swine ,Ectopic beat ,Cardiomyopathy ,Hemodynamics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Left Ventricular Epicardium ,Animals ,cardiovascular diseases ,030212 general & internal medicine ,Ventricular dyssynchrony ,Ejection fraction ,business.industry ,medicine.disease ,Ventricular Premature Complexes ,Bigeminy ,cardiovascular system ,Cardiology ,Swine, Miniature ,Right Ventricular Free Wall ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Abstract
The pathophysiology of cardiomyopathy associated with premature ventricular contractions (PVCs) remains unclear.This study prospectively explored cardiomyopathy development in a swine model of paced ectopic beats.A total of 35 swine underwent pacemaker implantation. A group exposed to paced bigeminy from the right ventricular apex (RVA) for 14 weeks (RVA PVC) (n = 10) were compared with a group exposed to regular pacing from the RVA at 140 beats/min (RV-140) (n = 5) and a control group (n = 5). To test the role of ectopic beat dyssynchrony, further groups were exposed for 12 weeks to bigeminy from the right ventricular free wall (RVFW PVC) (n = 5), the left ventricular epicardium (LV Epi PVC) (n = 5) or the right atrium (premature atrial complex) (n = 5).After 14 weeks, the mean left ventricular ejection fraction (LVEF) was significantly lower in the RVA PVC group than in the RV-140 or control groups (p 0.05). LVEF declined significantly in the LV Epi PVC (65.2 ± 2.4% to 39.7 ± 3.0%; p 0.01) and RVFW PVC (66.1 ± 2.6% to 48.6 ± 2.7%; p 0.01) groups, with final LVEF significantly lower and ventricular fibrosis significantly higher in the LV Epi PVC group compared with all others (p 0.05). Protein levels of pRyR2, NCX-1, CaMKII-α, and PLN were up-regulated and levels of SERCA2a were down-regulated in the LV Epi PVC group compared with the control group (p 0.05). Longer ectopic beat QRS duration and greater LV dyssynchrony were significantly associated with larger declines in LV systolic function.In a swine model of paced ectopic beats, PVC-induced cardiomyopathy is phenotypically distinct from a tachycardia-induced cardiomyopathy. Cardiomyopathy severity is strongly associated with severity of the hemodynamic derangement associated with the paced ectopic beats, particularly the extent of LV dyssynchrony.
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- 2018
305. Right ventricular dyssynchrony and functional capacity before and after percutaneous balloon mitral valvuloplasty in patients with mitral stenosis: Determinants and clinical impact
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Mohamed Gouda, Islam Galal, Ragab A. Mahfouz, and Mohamed I. Amin
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Adult ,Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,Percutaneous ,Mitral valvuloplasty ,Heart Ventricles ,Ventricular Dysfunction, Right ,030204 cardiovascular system & hematology ,Balloon ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,Medicine ,Humans ,Mitral Valve Stenosis ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,Ventricular dyssynchrony ,business.industry ,Walking test ,medicine.disease ,Brain natriuretic peptide ,Stenosis ,Treatment Outcome ,Echocardiography ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
We aimed to investigate the utility of right ventricular (RV) dyssynchrony to assess functional capacity utilizing 6-minute walking test distance (6MWTD) and to measure brain natriuretic peptide levels (BNP) in patients with mitral stenosis (MS) and to study its value to predict adverse outcome following percutaneous balloon mitral valvuloplasty (PBMV).A total of 108 patients with moderate to severe MS (26.5 ± 7.5 years) were included in this study. All were candidates for PBMV. RV strain curves were obtained using two-dimensional speckle-tracking echocardiography, and standard deviation (SD) of 4 segments without RV apex (-SD4) was also assessed. 6MWT and BNP were before and after 12 months following PBMV.RV-SD4 was significantly prolonged in patients with MS compared with controls (P 0.001). Patients with 6MWTD ≤300 m had a significantly increased RV-SD4 (P 0.001) and had higher BNP values (P 0.03) compared with those with 6MWTD300 m. RV-SD4 showed a strong correlation with 6MWT and BNP level. RV-SD4 was the strongest independent predictor of adverse outcome following PBMV (P 0.0001). Receiver operating characteristic analysis showed that RV-SD4 ≥24 ms was the cutoff value which predicts the adverse outcome following PBMV. A considerable improvement of mean 6MWT with significant reduction of BNP levels after 12 months of follow-up (P 0.001) in subjects with RV dyssynchrony24 ms.Right ventricular dyssynchrony is a useful predictor of functional status, as assessed with 6MWTD and BNP level in patients with MS. Furthermore, it might be considered as an independent predictor of adverse outcome following PMBV.
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- 2018
306. Pharmacologic therapy with flecainide for asymptomatic Wolff-Parkinson-White syndrome in an infant with severe left ventricular dyssynchrony
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Sayo Suzuki, Mari Iwamoto, and Tatsunori Hokosaki
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Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Heart Ventricles ,030204 cardiovascular system & hematology ,Asymptomatic ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacologic therapy ,cardiovascular diseases ,030212 general & internal medicine ,Ventricular dyssynchrony ,Flecainide ,Complete response ,business.industry ,Infant ,General Medicine ,medicine.disease ,Echocardiography ,Pediatrics, Perinatology and Child Health ,Cardiology ,Electrocardiography, Ambulatory ,Wolff-Parkinson-White Syndrome ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Some asymptomatic patients with Wolff–Parkinson–White syndrome have severe left ventricular dyssynchrony and dysfunction. We describe a patient who was given a diagnosis of Wolff–Parkinson–White syndrome in infancy and had a complete response to pharmacologic therapy with flecainide. Our findings suggest that flecainide is a suitable resynchronisation therapy for such infants.
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- 2018
307. Assessment of left ventricular dyssynchrony by three-dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy
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Jeroen J. Bax, Ulas Höke, Nina Ajmone Marsan, and Victoria Delgado
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Male ,medicine.medical_specialty ,Time Factors ,Systole ,medicine.medical_treatment ,dyssynchrony ,Cardiac resynchronization therapy ,Echocardiography, Three-Dimensional ,Renal function ,cardiac resynchronization therapy ,Subgroup analysis ,030204 cardiovascular system & hematology ,Risk Assessment ,Ventricular Function, Left ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,three-dimensional echocardiography ,Humans ,030212 general & internal medicine ,Registries ,Ventricular dyssynchrony ,Aged ,Heart transplantation ,business.industry ,Area under the curve ,Reproducibility of Results ,Atrial fibrillation ,Stroke Volume ,Recovery of Function ,Middle Aged ,medicine.disease ,Treatment Outcome ,Quartile ,Cardiology ,Disease Progression ,Heart Transplantation ,Female ,Heart-Assist Devices ,prognosis ,systolic dyssynchrony index ,Cardiology and Cardiovascular Medicine ,business - Abstract
Systolic dyssynchrony index (SDI) using three-dimensional echocardiography (3DE) was shown to be a reliable measure of left ventricular (LV) dyssynchrony. However, the prognostic value of SDI on long-term outcomes after cardiac resynchronization therapy (CRT) remains unknown.A total of 414 patients (mean age 67 ± 10 years, 60% ischemic etiology) with 3DE evaluation before CRT implantation were included. SDI was evaluated as continuous value and in quartiles. The study endpoint was combined all-cause mortality, heart transplantation, and LV assist device implantation. At baseline, median SDI was 8.0% (IQR 5.6-11.3%). During a median follow-up of 45 months (IQR 25-59 months), the endpoint was observed in 94 (23%) patients. SDI was independently associated with the endpoint together with ischemic etiology, diabetes, and renal function (HR 0.914, P = 0.003) after adjustment for age, atrial fibrillation, hemoglobin level, NYHA functional class, and posterolateral LV lead position. Patients from the 1st, 2nd, and 3rd SDI quartiles showed similar survival and superior as compared to the 4th quartile with the lowest SDI values (≤5.5%; χ²: 30.4, log-rank P 0.001). From receiver operating characteristic curve analysis, the optimal SDI cut-off value associated with the endpoint was 6.8% (area under the curve 0.634). Finally, a subgroup analysis (293 patients) demonstrated that a more pronounced reduction in SDI immediately after CRT (resynchronization) was independently associated with superior survival (HR 0.461, P = 0.011) after adjustment for prognostic relevant parameters.SDI is independently associated with long-term prognosis after CRT and might therefore be important to optimize risk-stratification in these patients.
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- 2018
308. Myocardial stunning-induced left ventricular dyssynchrony on gated single-photon emission computed tomography myocardial perfusion imaging
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Haipeng Tang, Dianfu Li, Cheng Wang, Weihua Zhou, Yanli Zhou, Qijun Shan, Zhixin Jiang, and Jianzhou Shi
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Male ,medicine.medical_specialty ,Gated SPECT ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Single-photon emission computed tomography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,Myocardial perfusion imaging ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ventricular dyssynchrony ,Myocardial Stunning ,Myocardial stunning ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,General Medicine ,Middle Aged ,medicine.disease ,Coronary arteries ,medicine.anatomical_structure ,Cardiology ,Myocardial infarction complications ,Female ,business ,Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - Abstract
OBJECTIVES Myocardial stunning provides additional nonperfusion markers of coronary artery disease (CAD), especially for severe multivessel CAD. The purpose of this study is to assess the influence of myocardial stunning to the changes of left ventricular mechanical dyssynchrony (LVMD) parameters between stress and rest gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). PATIENTS AND METHODS A total of 113 consecutive patients (88 males and 25 females) who had undergone both stress and rest Tc-sestamibi gated SPECT MPI were retrospectively enrolled. Suspected or known patients with CAD were included if they had exercise stress MPI and moderate to severe myocardial ischemia. Segmental scores were summed for the three main coronary arteries according to standard myocardial perfusion territories, and then regional perfusion, wall motion, and wall thickening scores were measured. Myocardial stunning was defined as both ischemia and wall dysfunction within the same coronary artery territory. Patients were divided into the stunning group (n=58) and nonstunning group (n=55). RESULTS There was no significant difference of LVMD parameters between stress and rest in the nonstunning group. In the stunning group, phase SD and phase histogram bandwidth of contraction were significantly larger during stress than during rest (15.05±10.70 vs. 13.23±9.01 and 46.07±34.29 vs. 41.02±32.16, P
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- 2018
309. Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function
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Jing Yao, Xiang-Qing Kong, and Mohammad Reeaze Khurwolah
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Diastole ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Article ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Diastolic function ,ventricular dyssynchrony ,030212 general & internal medicine ,Ventricular dyssynchrony ,cardiac resynchronisation therapy ,Right ventricular ,Physiological function ,business.industry ,General Medicine ,Ventricular pacing ,medicine.disease ,diastolic ,Heart failure ,Cardiology ,Female ,systolic ,apical pacing ,Cardiology and Cardiovascular Medicine ,business ,Single chamber - Abstract
Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssynchrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been proposed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alternative Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term outcomes of patients with RV septal pacing will be explored.
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- 2018
310. Right ventricular dyssynchrony and its improvements after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
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Beste Ozben, Batur Gonenc Kanar, Ruya Aydın, Elif Yildirim, and Ipek Ozmen
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Male ,medicine.medical_specialty ,Turkey ,medicine.medical_treatment ,Heart Ventricles ,Ventricular Dysfunction, Right ,Pulmonary disease ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pulmonary rehabilitation ,Ventricular dyssynchrony ,COPD ,Receiver operating characteristic ,business.industry ,Echogenicity ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose Whether pathologic alterations of right ventricle (RV) in chronic obstructive pulmonary disease (COPD) affect intra- and interventricular dyssynchrony due to changes in mechanical activation of the septum and RV is unclear. The aim of this study was to determine mechanical activation and its changes after pulmonary rehabilitation program (PRP) with speckle tracking echocardiography (STE) in COPD patients. Methods After the exclusion of 15 patients due to poor echogenicity and 5 patients not tolerating PRP out of 69 consecutive COPD patients undergoing PRP, the remaining 49 patients and 41 healthy subjects were enrolled. The mechanical activations of both ventricles were evaluated at admission and after PRP with STE. Results Chronic obstructive pulmonary disease patients had intra- and interventricular dyssynchrony compared to controls. The interventricular dyssynchrony assessed by time to peak longitudinal systolic strain (PLSS) difference between RV free wall and left ventricle (LV) lateral wall and intraventricular dyssynchrony assessed by RV peak systolic strain dyssynchrony (PSSD) index were improved after PRP. In all, 18 patients were hospitalized due to symptoms of right heart failure within 1 year. The time to PLSS difference between RV free wall and LV lateral wall and RV PSSD index were independent predictors of hospitalization. Receiver operating characteristics (ROC) analysis revealed that a time to PLSS difference between RV free wall and LV lateral wall >15 ms predicted hospitalization within 1 year with 77.8% sensitivity and 64.5% specificity. Conclusions Chronic obstructive pulmonary disease was associated with intra- and interventricular dyssynchrony. PRP had an important impact on the improvement of both intra-, and interventricular dyssynchrony, which might be used in predicting hospitalization within 1 year.
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- 2018
311. His Bundle Pacing: Rebirth of an Important Technique for Pacing the Intrinsic Conduction System
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Macc C. Richard Conti, William M. Miles, Md, Facc, Fhrs, Thomas A. Burkart, Md, Facc, Fhrs, Fhrs Matthew S. McKillop, Michael Kaufmann, and Mark Panna, Md, Facc, Fhrs
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Physics ,lcsh:Diseases of the circulatory (Cardiovascular) system ,permanent pacing ,lcsh:RC666-701 ,Bundle ,cardiovascular system ,cardiac resynchronization therapy ,ventricular dyssynchrony ,General Medicine ,Mechanics ,Electrical conduction system of the heart ,His-bundle pacing - Abstract
Permanent pacemaker implant is a commonly performed cardiac procedure for treatment of bradycardia or conduction system abnormality. With conventional right ventricular (RV) pacing a lead is implanted at the RV apex or on the RV septum. However, RV apical or RV septal pacing causes iatrogenic left bundle-branch block and ventricular dyssynchrony and can lead to adverse cardiac remodeling, a pacing-mediated cardiomyopathy, and congestive heart failure. Alternatively, permanent His-bundle pacing uses the intrinsic rapidly-conducting His-Purkinje system to activate the ventricle, thereby maintaining (or sometimes even restoring) ventricular synchrony. Many patients may derive benefit from permanent His-bundle pacing.
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- 2018
312. Short‐term Changes in Left Ventricular Dyssynchrony Leads to Congestive Heart Failure
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Jasmin Jessica Hurtado
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medicine.medical_specialty ,business.industry ,medicine.disease ,Biochemistry ,Term (time) ,Heart failure ,Internal medicine ,Genetics ,medicine ,Cardiology ,business ,Ventricular dyssynchrony ,Molecular Biology ,Biotechnology - Published
- 2018
313. Understanding Mechanisms of Cardiac Resynchronization Therapy Response to Improve Patient Selection and Outcomes
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Larisa G. Tereshchenko, Jonathan W. Waks, and Erick A. Perez-Alday
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medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Ventricular dyssynchrony ,Ventricular remodeling ,Heart Failure ,Ejection fraction ,Left bundle branch block ,business.industry ,Patient Selection ,medicine.disease ,Heart failure ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
See Article by Huntjens et al Medical therapy for systolic heart failure improves symptoms, functional capacity, and survival. However, despite optimal medical therapy, many patients with significantly depressed left ventricular (LV) systolic function continue to have symptoms that limit functionality and quality of life. Deleterious hemodynamics effects of asynchronous activation of the myocardium have been recognized for almost a century.1 Many patients with LV dysfunction have additional interventricular or intraventricular dyssynchrony, which can further impair cardiac output2 and which, in some cases, may be the primary cause of LV dysfunction itself.3 Ventricular dyssynchrony results in adverse changes in ventricular loading and hemodynamics, cardiac blood flow and energy metabolism, gene and protein expression, and valvular regurgitation, eventually culminating in progressive adverse ventricular remodeling, which can cause further deterioration of LV function.4 Cardiac resynchronization therapy (CRT) targets and treats ventricular dyssynchrony and has been associated with reduced heart failure hospitalization, improved functional status, better quality of life, and decreased mortality in multiple randomized controlled trials (RCTs).5 CRT implantation is an invasive procedure associated with both procedural risk6 and cost. Unfortunately, all patients who meet current guidelines for CRT implantation7 (which focus primarily on LV ejection fraction, New York Heart Association functional class, and QRS duration/morphology) do not experience benefit from CRT, and despite extensive study, optimal patient selection for CRT remains elusive. QRS duration, left bundle branch block (LBBB), and other clinical and demographic parameters have been associated with rates of CRT response,8 and CRT implantation using echocardiographic9 or electrogram-guided10 LV lead positioning have been proposed as ways to improve CRT response rates, but even with improved technology, ≈30% …
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- 2018
314. Right ventricular dyssynchrony during hypoxic breathing but not during exercise in healthy subjects: a speckle tracking echocardiography study
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Vitalie Faoro, Roberto Badagliacca, Beatrice Pezzuto, Kevin Forton, Yoshiki Motoji, and Robert Naeije
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Adult ,Male ,medicine.medical_specialty ,Elevated pulmonary artery pressure ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Afterload ,Physiologie générale ,Heart Rate ,Internal medicine ,medicine.artery ,pulmonary hypertension ,medicine ,Humans ,cardiovascular diseases ,Ventricular dyssynchrony ,speckle tracking echocardiography ,Hypoxia ,Exercise ,exercise ,business.industry ,hypoxia ,Respiration ,General Medicine ,Hypoxia (medical) ,medicine.disease ,Pulmonary hypertension ,right ventricular dyssynchrony ,medicine.anatomical_structure ,Enseignement des sciences bio-médicales et agricoles ,Echocardiography ,Pulmonary artery ,Vascular resistance ,Cardiology ,cardiovascular system ,Ventricular Function, Right ,Female ,Vascular Resistance ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
What is the central question of this study? Right ventricular dyssynchrony in severe pulmonary hypertension is associated with a poor prognosis. However, it has recently been observed in patients with lung or connective tissue disease and pulmonary artery pressure at the upper limits of normal. The mechanisms of right ventricular dyssynchrony in pulmonary hypertension remain uncertain. What is the main finding and its importance? Acute hypoxic breathing, but not normoxic exercise, induces an increase in right ventricular dyssynchrony detected by speckle tracking echocardiography in healthy subjects. These results add new insights into the determinants of right ventricular dyssynchrony, suggesting a role for systemic factors added to afterload in the pathophysiology of right ventricular inhomogeneity of contraction., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2018
315. The Impact of Cardiac Resynchronization Therapy on the Frequency of Ventricular Arrhythmias
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Alexander Khodak, Adam S. Budzikowski, Ofek Hai, Cristina A. Mitre, and Andrew Beck
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Heart failure ,Biventricular defibrillator ,Cardiac resynchronization ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Ventricular dyssynchrony ,business ,Single chamber - Abstract
Background: Cardiac resynchronization therapy (CRT) has a proven role in improving mortality in patients with heart failure and ventricular dyssynchrony. However, the effects of biventricular pacing (CRT) on ventricular arrhythmia susceptibility have not been definitely established, and data regarding the risk of ventricular arrhythmias (VA) with CRT has been limited and conflicting.The aim of this study was to compare the burden of VA in the short term before and after an upgrade to a cardiac resynchronization device in order to avoid the long term effects of myocardial remodeling.Methods: We analyzed 44 consecutive patients with severe LV systolic dysfunction who underwent an upgrade from a single chamber defibrillator to biventricular defibrillator due to worsening heart failure status.Results: CRT was associated with a decrease in VA in patients with high arrhythmic burden, in women and in patients older than 65.Conclusion: In this study we provide convincing evidence that in patients with identical electrophysiological substrate, biventricular pacing alone is associated with a decrease in VA burden.
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- 2018
316. Echocardiography Evaluation of Left Ventricular Systolic Function, Systolic Dysfunction, and Ventricular Dyssynchrony
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Anita Sadeghpour, Nehzat Akiash, and Azin Alizadehasl
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Prognostic factor ,medicine.medical_specialty ,animal structures ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Speckle tracking echocardiography ,Stroke volume ,Systolic function ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,Ventricular dyssynchrony ,business - Abstract
The ejection fraction (EF) is the most widely used measure and popular method in evaluating left ventricular (LV) systolic function and is considered a critical prognostic factor in all types of heart diseases.
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- 2018
317. Assessment of Left Ventricular Dyssynchrony using Gated Myocardial Perfusion SPECT in Cardiac Resynchronization Therapy
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Masahisa Onoguchi, Takayuki Shibutani, and Manabu Nakamura
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Heart failure ,medicine ,Quantitative assessment ,Cardiology ,030212 general & internal medicine ,Maximum displacement ,Ventricular dyssynchrony ,business ,Phase analysis ,Perfusion - Abstract
In cardiac resynchronization therapy (CRT), even if patient selection is made according to Japanese adaptive criteria, there are non-responders. Its main factor is considered to be the lack of adequate preoperative assessment against mechanical left ventricular dyssynchrony. Recently, phase analysis was enabled on gated myocardial perfusion SPECT (GMPS). The purpose of this study was to examine the relationship between the index of phase analysis using the two software (cardioREPO® and QGS) and the left ventricular reverse remodeling index (ΔLVESV) for the evaluation of left ventricular dyssynchrony in CRT patients is there. It also evaluated whether it could be an index of adaptation decision and effect determination. Methods: For 15 patients with severe heart failure who underwent CRT, GMPS was performed before (baseline) and after CRT. In cardioREPO®, standard deviation of the time to end systolic phase of 17 segments of the left ventricle (SDTES) and Bandwidth and Phase SD, Entropy of phase histogram were used as left ventricular dyssynchrony index. In QGS, standard deviation of the time to maximum displacement of each segment (SDTTMD) was used as an index. An example in which ΔLVESV (%Reduction) after 6 months of CRT decreased by 15% or more was defined as a CRT responder. Results: 10 of 15 patients were responders. Bandwidth at baseline of the responder group was significantly higher. SDTES, Phase SD, Entropy and SDTTMD of the responder group tended to be higher. All indexes decreased significantly in the responder group after 6 months of CRT but not in the non-responder group. Excluding SDTES, positive correlation was shown between baseline and ΔLVESV, and the optimal cutoff value of responder prediction was SDTES 7.637%, Bandwidth 218°, Phase SD 50.0°, Entropy 0.785, SDTTMD 19.85 ms. Conclusion: Phase analysis by GMPS showed that quantitative assessment of left ventricular dyssynchrony of CRT was possible and that the index was related to response prediction to CRT. In particular, SDTTMD showed good correlation between baseline and ΔLVESV, suggesting that it may be a more sensitive index of reaction prediction.
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- 2018
318. 300.15 Transcatheter Aortic Valve Replacement-Induced Left Ventricular Dyssynchrony: A Comparative Analysis Using Myocardial Strain and Electrocardiography
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Jeffrey J. Popma, Alexandre L. Bortolotto, Alexandre A. Marum, Michael J. Chen, Richard L. Verrier, Gordon M. Burke, Bruna Araujo Silva, James Chang, Sarah Fostello, and Bruce D. Nearing
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medicine.medical_specialty ,Bundle branch block ,medicine.diagnostic_test ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Strain (injury) ,medicine.disease ,Valve replacement ,Internal medicine ,Myocardial strain ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Ventricular dyssynchrony ,business ,Electrocardiography - Abstract
Specific strain echocardiogram and electrocardiogram (ECG) measures of mechanical and electrical ventricular dyssynchrony correlate in certain disease states. We hypothesized that strain and ECG measures of dyssynchrony would correlate in patients who develop a new left bundle branch block (LBBB) or
- Published
- 2019
319. Cardiac Resynchronization Therapy in Heart Failure: Do Evidence-Based Guidelines Follow the Evidence?
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Nandini Dendukuri, James M. Brophy, Eva Suarthana, and Nisha D. Almeida
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Male ,medicine.medical_specialty ,Evidence-based practice ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,law.invention ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Meta-Analysis as Topic ,Randomized controlled trial ,law ,medicine ,Humans ,Ventricular Function ,cardiovascular diseases ,Healthcare Disparities ,Ventricular dyssynchrony ,Intensive care medicine ,Randomized Controlled Trials as Topic ,Heart Failure ,Evidence-Based Medicine ,Ejection fraction ,business.industry ,030503 health policy & services ,Recovery of Function ,Canadian Cardiovascular Society ,medicine.disease ,Treatment Outcome ,Heart failure ,Practice Guidelines as Topic ,cardiovascular system ,Female ,0305 other medical science ,Cardiology and Cardiovascular Medicine ,business ,Systematic Reviews as Topic - Abstract
Cardiac resynchronization therapy (CRT) for ventricular dyssynchrony in patients with heart failure has seen a steady increase worldwide; yet evidence of its effectiveness in certain subgroups is unclear. Given the high cost and risk of complications associated with these implants and their replacements, there is a need for clear clinical practice guidelines. In this report, we explore the variability of recommendations in published clinical practice guidelines and determine the extent of their evidential support. We conducted an electronic search for the most recent clinical practice guidelines and health technology assessments (HTAs) pertaining to a first implant of CRT in patients with heart failure and a systematic review of all published randomized controlled trials (RCTs) that evaluated the efficacy of CRT in heart failure patients with left ventricular dyssynchrony.1 We evaluated the concordance between recommendations on CRT use and evidence from the corresponding RCTs and meta-analyses of these RCTs. Because most recommendations were made within patient subgroups (such as New York Heart Association [NYHA] class, QRS morphology, and QRS interval), we determined how well represented these subgroups were in the major trials. We identified 4 clinical practice guidelines and 4 HTAs (Table I in the Data Supplement). Figure compares the guidelines for first-time use of CRT issued by the 4 professional societies and 2 of the HTAs. Two other HTAs were not included in Figure because they did not make recommendations by subgroups. Figure. Comparison of guidelines issued by the professional societies and health technology assessments (HTAs) for the use of cardiac resynchronization therapy (CRT) in heart failure. *For patients who have left ventricular ejection fraction ≤30%, †for patients who have left ventricular ejection fraction ≤35%, and ‡strong statistical and clinical evidence of benefit. ACCF/AHA indicates American College of Cardiology Foundation/American Heart Association; CCS, Canadian Cardiovascular Society; CRT-D, cardiac resynchronization therapy …
- Published
- 2017
320. Analysis of Dyssynchrony and Ventricular Function in Right Univentricular Stimulation at Different Positions
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Ana Paula Susin Osório, Tiago Luiz Luz Leiria, Stefan Warpechowski Neto, Antonio Lessa Gaudie Ley, Eduardo Dytz Almeida, Laura Lessa Gaudie Ley, Marcelo Haertel Miglioranza, and Roberto T. Sant'Anna
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Pacemaker, Artificial ,Heart Ventricles ,Ventricular Dysfunction, Right ,lcsh:Surgery ,030204 cardiovascular system & hematology ,Contractility ,03 medical and health sciences ,QRS complex ,Electrocardiography ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Internal medicine ,medicine ,Ventricular Dysfunction ,Humans ,cardiovascular diseases ,Ventricular dyssynchrony ,Aged ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,Arrhythmias, Cardiac ,Stroke Volume ,lcsh:RD1-811 ,General Medicine ,Stroke volume ,medicine.disease ,Myocardial Contraction ,medicine.anatomical_structure ,Cross-Sectional Studies ,lcsh:RC666-701 ,Ventricle ,Echocardiography ,Heart failure ,Cardiology ,Ventricular Function, Right ,cardiovascular system ,Surgery ,Original Article ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Chronic stimulation of the right ventricle with pacemaker is associated with ventricular dyssynchrony and loss of contractility, even in subjects without previous dysfunction. In these patients, there is a debate of which pacing site is less associated with loss of ventricular function. Objective: To compare pacemaker-induced dyssynchrony among different pacing sites in right ventricular stimulation. Methods: Cross-sectional study of outpatients with right ventricle stimulation higher than 80% and preserved left ventricular ejection fraction. Pacing lead position (apical, medial septum or free wall) was assessed through chest X-rays. Every patient underwent echocardiogram to evaluate for dyssynchrony according to CARE-HF criteria: aortic pre-ejection time, interventricular delay and septum/posterior wall delay on M mode. Results: Forty patients were included. Fifty-two percent had apical electrode position, 42% mid septum and 6% free wall. Mean QRS time 148.97±15.52 milliseconds. A weak correlation between the mean QRS width and pre-aortic ejection time (r=0.32; P=0.04) was found. No difference in QRS width among the positions could be noted. Intraventricular delay was lower in apical patients against mid septal (34.4±17.2 vs. 54.3±19.1 P
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- 2017
321. Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging
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Ragab A. Mahfouz, Waleed S. Alawady, and Abdelhakeem Salem
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Male ,medicine.medical_specialty ,Adolescent ,Heart Ventricles ,Arthritis ,030204 cardiovascular system & hematology ,Doppler imaging ,Sensitivity and Specificity ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Adverse effect ,Ventricular dyssynchrony ,Child ,Subclinical infection ,business.industry ,Carditis ,Atrial fibrillation ,medicine.disease ,Echocardiography, Doppler ,Myocarditis ,Heart failure ,Cardiology ,Female ,Rheumatic Fever ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective We aimed to investigate the hypothesis that the presence of left ventricular (LV) dyssynchrony in children with acute rheumatic fever (ARF) children may be a predictor of latent rheumatic carditis. Methods Eighty-nine children with ARF and 45 healthy control children were included the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging. Results LV dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be prolonged in children with ARF than in controls (P
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- 2017
322. Exercise-induced left bundle branch block - A case report with stress-echocardiographic assessment
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Thomas Kümler, Jesper Jensen, and Juliane Theilade
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Male ,medicine.medical_specialty ,Bundle-Branch Block ,030204 cardiovascular system & hematology ,Diagnosis, Differential ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Ventricular dyssynchrony ,medicine.diagnostic_test ,Bundle branch block ,business.industry ,Chest discomfort ,Left bundle branch block ,Treatment options ,Biventricular pacemaker ,Middle Aged ,medicine.disease ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress - Abstract
We report the case of a 51-year-old male who presented with exertional chest discomfort and dyspnea concurring with an exercise-induced left bundle branch block (EI-LBBB). Possible underlying causes and treatment options are presented and discussed. The case represents the first stress-echocardiographic assessment of a case with EI-LBBB, performed in order to document a possible left ventricular dyssynchrony during the EI-LBBB and thereby the possible treatment option of biventricular pacemaker implantation.
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- 2017
323. Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three-dimensional echocardiography after fontan operation.
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Zhong SW, Zhang YQ, Chen LJ, Zhang ZF, Wu LP, and Hong WJ
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- Child, Heart Ventricles diagnostic imaging, Humans, Stroke Volume, Systole, Ventricular Function, Ventricular Function, Right, Echocardiography, Three-Dimensional, Fontan Procedure
- Abstract
Background: This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure., Methods: Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%)., Results: RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = -.570, p = 0.003)., Conclusions: RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation., (© 2021 Wiley Periodicals LLC.)
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- 2021
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324. Chronic pacing and adverse outcomes after transcatheter aortic valve implantation
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Augusto D. Pichard, Hasan Garan, Pamela S. Douglas, Raj Makkar, Howard C. Herrmann, Tamim Nazif, Angelo B. Biviano, Mathew R. Williams, E. Murat Tuzcu, Ke Xu, Samir R. Kapadia, Rebecca T. Hahn, Craig R. Smith, William F. Fearon, Wilson Y. Szeto, Jose Dizon, Martin B. Leon, Hasan Jilaihawi, Vasilis Babaliaros, Susheel Kodali, and Paul L. Hess
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Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Bundle-Branch Block ,law.invention ,Transcatheter Aortic Valve Replacement ,Electrocardiography ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Adverse effect ,Ventricular dyssynchrony ,Survival rate ,Aged, 80 and over ,medicine.diagnostic_test ,Bundle branch block ,Left bundle branch block ,business.industry ,Aortic Valve Stenosis ,Prognosis ,medicine.disease ,United States ,Survival Rate ,Treatment Outcome ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p0.01). Prior PPM had worsened recovery of LVEF after TAVI (Δ=10.0 prior vs 19.7% no PPM for baseline LVEF35%, p0.0001; Δ=4.1 prior vs 7.4% no PPM for baseline LVEF 35-50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (88%).In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings.(ClinicalTrials.gov NCT00530894).
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- 2015
325. Reflections on EchoCRT: sound guidance on QRS duration and morphology for CRT?: Figure 1
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Yura Mareev, Cecilia Linde, and John G.F. Cleland
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medicine.medical_specialty ,Mitral regurgitation ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Subgroup analysis ,Narrow QRS complex ,medicine.disease ,law.invention ,QRS complex ,Randomized controlled trial ,law ,Internal medicine ,Heart failure ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Ventricular dyssynchrony ,circulatory and respiratory physiology - Abstract
This editorial refers to ‘The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT Trial’, by J. Steffel et al ., on page doi:10.1093/eurheartj/ehv242. Guidelines give a strong recommendation for cardiac resynchronization therapy (CRT) for selected patients with heart failure.1,2 These recommendations are relatively complex and could be improved and simplified in the light of new data. In this issue of the journal, the EchoCRT investigators show, in a prospective randomized controlled trial, that patients with a QRS duration or
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- 2015
326. Prognostic significance of NT-proBNP, 3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary percutaneous intervention
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A. Vamsidhar, Velam Vanajakshamma, Durgaprasad Rajasekhar, C. Siva Sankara, and B.S. Praveen Kumar
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Male ,Percutaneous ,Cardiac Volume ,Echocardiography, Three-Dimensional ,Doppler imaging ,Ventricular Function, Left ,Electrocardiography ,Ventricular Dysfunction, Left ,Natriuretic Peptide, Brain ,Medicine ,Myocardial infarction ,Left ventricular dyssynchrony ,Ejection fraction ,Ventricular Remodeling ,Middle Aged ,Prognosis ,Echocardiography, Doppler ,Disease Progression ,Cardiology ,cardiovascular system ,Female ,Original Article ,Cardiology and Cardiovascular Medicine ,hormones, hormone substitutes, and hormone antagonists ,medicine.medical_specialty ,Acute coronary syndrome ,RD1-811 ,Percutaneous Coronary Intervention ,Internal medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Left atrial volume ,Heart Atria ,cardiovascular diseases ,Ventricular dyssynchrony ,Retrospective Studies ,business.industry ,medicine.disease ,ST-Elevation myocardial infarction ,Peptide Fragments ,NT-proBNP ,Heart failure ,RC666-701 ,Conventional PCI ,ST Elevation Myocardial Infarction ,Surgery ,business ,Primary percutaneous intervention ,Biomarkers ,Follow-Up Studies - Abstract
Objectives The aim of the present study was to assess the short term prognostic significance of N-terminal pro BNP (NT-proBNP), 3D left atrial volume (LAV) and left ventricular (LV) dyssynchrony in patients of acute ST-elevation myocardial infarction (STEMI) who underwent primary Percutaneous intervention (PCI). Background NT-proBNP, LV dyssynchrony and LAV in patients with acute coronary syndrome have been associated with PCI outcomes and predict the short and long-term prognosis. Methods This study consisted of 142 patients with a first STEMI who underwent primary PCI. Baseline echocardiographic data was collected at admission and at 6 months follow up. Left ventricular dyssynchrony was measured by tissue Doppler imaging and LAV by real time 3D-echocardiography, plasma NT-proBNP levels were estimated between 72 and 96 h of admission. Results During study period 3 patients expired and 4 developed congestive heart failure (CHF). Baseline NT-proBNP and LV dyssynchrony correlated with LV size and LV ejection fraction (LVEF) at baseline and during follow up. Patients with higher NT-proBNP levels and higher LV dyssynchrony showed significant increase in LV size with decrease in LVEF during follow-up. Baseline Left atrial volume index (LAVI) showed significant correlation with LV size but no association with LVEF at baseline and during follow-up. Conclusions Higher levels of NT-proBNP and higher LV dyssynchrony can predict patients with increase in LV size, worsening of LV systolic and diastolic function during follow-up. Patients with higher NT-proBNP levels at baseline developed CHF during follow-up.
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- 2015
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327. Contralateral transvenous left ventricular lead placement of implantable devices with pre-sternal tunnelling in chronically obstructed subclavian veins
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Praveen P. Sadarmin, Rajesh K. Chelliah, and Jonathan Timperley
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Ventricular lead ,business.industry ,Case Report ,medicine.disease ,Implantable cardioverter defibrillators ,Venous access ,Transvenous leads ,Blocked veins ,lcsh:RC666-701 ,Physiology (medical) ,Internal medicine ,Cardiology ,cardiovascular system ,Cardiac resynchronisation therapy ,Medicine ,cardiovascular diseases ,Device upgrade ,Cardiology and Cardiovascular Medicine ,business ,Ventricular dyssynchrony ,Medical therapy ,Tunnelled lines - Abstract
Cardiac resynchronisation therapy (CRT) is a recognised therapy for the management of severe left ventricular dysfunction, advanced congestive cardiac failure (NYHA III or IV), ventricular dyssynchrony (either broad LBBB or mechanical dyssynchrony on echocardiography) and failure of optimal medical therapy to achieve improvement in clinical status. Upgrading right ventricular pacemakers or defibrillators to biventricular devices is common and we describe here, 2 such cases of biventricular upgrade with blocked venous access on the ipsilateral side and successful placement of left ventricular leads following pre-sternal tunnelling from the contralateral side.
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- 2015
328. Comparison of early effects of right ventricular apical pacing on left ventricular functions in single and dual chamber pacemakers
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Alaa Solaiman Algazzar, M.A. Moharram, Azza Ali Katta, Walaa Farid Abd ElAziz, and Ghada Soltan
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Ventricular function ,business.industry ,Significant difference ,Diastole ,medicine.disease ,Brain natriuretic peptide ,Ddd pacing ,Dyssynchrony ,lcsh:RC666-701 ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,Pacing ,In patient ,cardiovascular diseases ,Myocardial Performance Index ,Cardiology and Cardiovascular Medicine ,business ,Ventricular dyssynchrony ,BNP - Abstract
Objectives: Our study aimed to demonstrate the early negative impact of right ventricular apical pacing induced by single (VVI) and dual chamber (DDD) pacemakers on LV functions in patients with preserved EF. And to assess that single brain natriuretic peptide (BNP) after 2 months of implantation is correlated to ventricular dyssynchrony. Methods: 40 patients with implanted VVI and DDD pacemakers were examined before implantation and again after 2 and 6 months of implantation for BNP, left ventricular (LV) systolic and diastolic functions by echocardiography and pulsed tissue Doppler. After 6 months, patients with DDD pacemakers were crossed over to VVI mode of pacing for 2 weeks with lower rate programed to 60 beat per minute then sample for BNP was collected again. Results: There was no statistically significant difference in LV systolic and diastolic functions except for myocardial performance index (MPI) with (P value of 0.03). Mean BNP level in VVI pacing was higher than DDD pacing after two months with P value = 0.001 while comparison after 6 months showed P value = 0.023. There was a statistically significant difference between both groups in results of aortic preejection delay (APED) (P value of
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- 2015
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329. Impact of baseline PR interval on cardiac resynchronization therapy outcomes in patients with narrow QRS complexes: an analysis of the ReThinQ Trial
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Matthew Stopper, Nikhil P. Joshi, John F. Beshai, Behzad B. Pavri, and Jianqing Li
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,law.invention ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,Oxygen Consumption ,Randomized controlled trial ,law ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,PR interval ,Ventricular dyssynchrony ,Retrospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,VO2 max ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,Echocardiography ,Heart failure ,Exercise Test ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Heart failure (HF) is a major cause of morbidity and mortality, and ventricular dyssynchrony is an important contributor. The ReThinQ trial reported no improvement with cardiac resynchronization therapy (CRT) in HF patients with left ventricular ejection fraction (LVEF)
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- 2015
330. Left Ventricular Dyssynchrony by Three-Dimensional Echocardiography: Current Understanding and Potential Future Clinical Applications
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Qiangjun Cai and Masood Ahmad
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Echocardiography, Three-Dimensional ,Cardiac resynchronization therapy ,Left ventricular hypertrophy ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,education ,Ventricular dyssynchrony ,education.field_of_study ,Evidence-Based Medicine ,business.industry ,Diastolic heart failure ,Stroke Volume ,Three dimensional echocardiography ,Image Enhancement ,medicine.disease ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Forecasting - Abstract
Left ventricular mechanical dyssynchrony is an important prognostic factor for patients with symptomatic systolic heart failure and has emerged as a therapeutic target for cardiac resynchronization therapy (CRT). However, approximately one-third of patients fail to improve after CRT based on current guideline recommendations and electrocardiographic criteria. Two-dimensional echocardiography and tissue Doppler-based techniques have shown variable results in assessment of left ventricular (LV) dyssynchrony and have limited value in clinical practice. Three-dimensional echocardiography (3DE) is an appealing novel imaging modality that has been recently used in quantitative evaluation of global and regional LV function. There is accumulating evidence that 3DE measurement of LV systolic dyssynchrony index may potentially play a role in predicting the short- and long-term response to CRT and further improve patient selection for CRT. New developments in 3DE speckle tracking technique and strain analysis may further improve the accuracy of LV mechanical dyssynchrony assessment in this population. In addition, recent studies suggest that mechanical dyssynchrony is present in patients with LV hypertrophy and diastolic heart failure. Three-dimensional echocardiographic assessment of dyssynchrony may aid in diagnosis and in predicting long-term outcome in these patients. We will summarize current understanding of 3DE techniques and parameters in assessment of LV mechanical dyssynchrony in the population of patients with systolic heart failure, LV hypertrophy, and diastolic heart failure. A number of the novel 3DE techniques described in this review are early in their stage of development, and they will continue to evolve and need further testing in large multicenter studies.
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- 2015
331. Cardiac resynchronisation therapy in patients with chronic heart failure
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Gautam G. Lalani and Ulrika Birgersdotter-Green
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medicine.medical_specialty ,genetic structures ,Severity of Illness Index ,Cardiac Resynchronization Therapy ,Internal medicine ,Severity of illness ,medicine ,Humans ,In patient ,Cardiac Resynchronization Therapy Devices ,cardiovascular diseases ,Ventricular remodeling ,Ventricular dyssynchrony ,Randomized Controlled Trials as Topic ,Heart Failure ,Ventricular Remodeling ,business.industry ,Stroke Volume ,Stroke volume ,medicine.disease ,Review article ,Treatment Outcome ,Heart failure ,Practice Guidelines as Topic ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Cardiac resynchronisation therapy (CRT) is common treatment for congestive heart failure (HF) with decreased LV function and wide QRS complex. Its foundations are set in the understanding of the pathophysiology of ventricular dyssynchrony. Over the last several decades, CRT has evolved through changes in implantation techniques, device and lead design, imaging modalities and our growing clinical experience. This review article will discuss the vast clinical experience that has led to current guidelines recommendations for CRT in patients with mild-to-severe HF. In addition, the article will also discuss recent evidence of benefits of CRT in patients beyond the guidelines. The article will also address the issue of non-responders, optimisation of CRT, postimplant evaluation and remote monitoring.
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- 2015
332. Association of subclinical atherosclerosis using carotid intima-media thickness, carotid plaque, and coronary calcium score with left ventricular dyssynchrony: The multi-ethnic Study of Atherosclerosis
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Bharath Ambale-Venkatesh, David A. Bluemke, Matthew C. Tattersall, James H. Stein, Colin O. Wu, Claudia E. Korcarz, Joseph F. Polak, Gustavo J. Volpe, Boaz D. Rosen, Ravi K. Sharma, Karol E. Watson, Joao A.C. Lima, James C. Carr, Khurram Nasir, and Sirisha Donekal
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Male ,medicine.medical_specialty ,Carotid Artery, Common ,Heart Ventricles ,Bundle-Branch Block ,Population ,Gadolinium ,Carotid Intima-Media Thickness ,Asymptomatic ,Article ,Ventricular Dysfunction, Left ,Risk Factors ,Internal medicine ,medicine.artery ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Common carotid artery ,education ,Ventricular dyssynchrony ,Aged ,Aged, 80 and over ,education.field_of_study ,Ejection fraction ,business.industry ,Myocardium ,Calcinosis ,Middle Aged ,Atherosclerosis ,medicine.disease ,Magnetic Resonance Imaging ,Plaque, Atherosclerotic ,Coronary Calcium Score ,Carotid Arteries ,Intima-media thickness ,Cardiovascular Diseases ,Multivariate Analysis ,cardiovascular system ,Cardiology ,Calcium ,Female ,Radiology ,Internal carotid artery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
The role of atherosclerosis in the progression of global left ventricular dysfunction and cardiovascular events has been well recognized. Left ventricular (LV) dyssynchrony is a measure of regional myocardial dysfunction. Our objective was to investigate the relationship of subclinical atherosclerosis with mechanical LV dyssynchrony in a population-based asymptomatic multi-ethnic cohort.Participants of the Multi-Ethnic Study of Atherosclerosis (MESA) at exam 5 were evaluated using 1.5T cardiac magnetic resonance (CMR) imaging, carotid ultrasound (n = 2062) for common carotid artery (CCA) and internal carotid artery (ICA) intima-media thickness (IMT), and cardiac computed tomography (n = 2039) for coronary artery calcium (CAC) assessment (Agatston method). Dyssynchrony indices were defined as the standard deviation of time to peak systolic circumferential strain (SD-TPS) and the difference between maximum and minimum (max-min) time to peak strain using harmonic phase imaging in 12 segments (3-slices × 4 segments). Multivariable regression analyses were performed to assess associations after adjusting for participant demographics, cardiovascular risk factors, LV mass, and ejection fraction. In multivariable analyses, SD-TPS was significantly related to measures of atherosclerosis, including CCA-IMT (8.7 ms/mm change in IMT, p = 0.020), ICA-IMT (19.2 ms/mm change in IMT, p0.001), carotid plaque score (1.2 ms/unit change in score, p0.001), and log transformed CAC+1 (0.66 ms/unit log-CAC+1, p = 0.018). These findings were consistent with other parameter of LV dyssynchrony i.e. max-min.In the MESA cohort, measures of atherosclerosis are associated with parameters of subclinical LV dyssynchrony in the absence of clinical coronary event and left-bundle-branch block.
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- 2015
333. Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome
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M Ravishankar, Amrutha Bindu Nagella, Kusha Nag, Dewan Roshan Singh, and V R Hemanth Kumar
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,asymptomatic sick sinus syndrome ,Case Report ,right ventricular outflow tract temporary pacing ,medicine.disease ,Asymptomatic ,Anesthetic management ,Sick sinus syndrome ,Surgery ,Transvenous pacing ,Prone position ,medicine.anatomical_structure ,Anesthesia ,Materials Chemistry ,medicine ,Ventricular outflow tract ,medicine.symptom ,business ,Percutaneous nephrolithotomy ,Ventricular dyssynchrony ,Sinus (anatomy) - Abstract
A 60-year-old woman posted for percutaneous nephrolithotomy with ureterolithotripsy was found to have a history of hypertension and ischemic heart disease from past 6 months on regular treatment. Pulse rate was irregularly irregular in a range of 56-60/min, unresponsive to atropine, with a sinus pause on the electrocardiogram. Although the patient was asymptomatic, anticipating unmasking of the sick sinus syndrome during general anesthesia in the prone position, a temporary pacemaker was implanted at right ventricular outflow tract (RVOT) septum before the scheduled surgery. A balanced anesthesia technique with endotracheal intubation was administered. There were several episodes of continuous pacing by the temporary pacemaker intraoperatively, which may be attributed to unmasking of the sinus node dysfunction due to general anesthesia. At the end of surgery, patient was extubated after adequate reversal from neuromuscular blockade. Postoperative period remained uneventful, and the pacemaker wires were removed on the 2(nd) postoperative day. With this case report, we highlight the importance of inserting a temporary pacemaker prior to anesthesia even in an asymptomatic patient if a sinus node dysfunction is suspected preoperatively and if intraoperative access to transvenous pacing is difficult such as in prone position. Pacing at RVOT septum minimizes ventricular dyssynchrony and improves hemodynamic parameters.
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- 2015
334. Diagnostic Value of Vasodilator-Induced Left Ventricular Dyssynchrony as Assessed by Phase Analysis to Detect Multivessel Coronary Artery Disease
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Chie Shiba, Hirokazu Tanaka, Yasuhiro Usui, Tsuguhisa Hatano, Satoshi Hida, Akira Yamashina, Yuko Igarashi, and Taishiro Chikamori
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Cultural Studies ,History ,Literature and Literary Theory ,medicine.diagnostic_test ,business.industry ,CAD ,Vasodilation ,medicine.disease ,SSS ,Coronary artery disease ,Medicine ,cardiovascular diseases ,business ,Ventricular dyssynchrony ,Nuclear medicine ,Phase analysis ,Perfusion ,Emission computed tomography - Abstract
Purpose: Phase analysis was recently developed to allow left ventricular(LV)mechanical dyssynchrony to be assessed by gated single-photon emission computed tomography(SPECT) . However, few studies have analyzed LV dyssynchrony during pharmacological stress and at rest by applying phase analysis to detect multivessel coronary artery disease(CAD)using the SyncTool TM . Methods: Adenosine triphosphate(ATP)loading electrocardiogram-gated 99m Tc-sestamibi SPECT was performed on 180 patients with suspected or known CAD. LV dyssynchrony was evaluated using the SyncTool TM ; the phase standard deviation(SD)and histogram bandwidth were derived. Results: The summed stress score(SSS) , summed difference score(SDS) , post-stress increase in phase SD, and histogram bandwidth were greater in 78 patients with multivessel CAD than in 102 patients with insignificant or single-vessel CAD. In the detection of multivessel CAD, SSS of >9 and SDS of >5 showed sensitivities of 74% and 74%,and specificities of 71% and 78% respectively, whereas an increase in phase SD>8.3°and in histogram bandwidth >16°after ATP loading had sensitivities of 62% and 74% and specificities of 77% and 68%, respectively. A multivariate logistic analysis revealed that the identification of multivessel CAD was superior with the combination of a post-ATP increase in phase SD, increase in histogram bandwidth, and SDS(sensitivity 82%, specificity 76%, chi-square=80.0)than with SDS alone (sensitivity 74%, specificity 78%, chi-square=58.9) . Conclusion: The addition of ATP-induced LV dyssynchrony parameters to conventional perfusion analysis enabled the superior identification of patients with multivessel CAD.
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- 2015
335. Acute Renal Injury Induced by Hypersensitivity to Tolvaptan in an Elderly Patient with Congestive Heart Failure
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Kazuo Kitamura, Takayuki Okubo, Kensaku Nishihira, Masashi Yamaguchi, and Yujiro Asada
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Receptors, Vasopressin ,medicine.medical_specialty ,Exacerbation ,Hyperkalemia ,Tolvaptan ,Blood Pressure ,Drug Hypersensitivity ,Edema ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Ventricular dyssynchrony ,Aged, 80 and over ,Heart Failure ,Mitral regurgitation ,business.industry ,Atrial fibrillation ,General Medicine ,Acute Kidney Injury ,Benzazepines ,medicine.disease ,Heart failure ,Cardiology ,Female ,medicine.symptom ,business ,Antidiuretic Hormone Receptor Antagonists ,medicine.drug - Abstract
Tolvaptan (TLV) is a new vasopressin type 2 receptor antagonist effective in patients with heart failure (HF). We herein describe the case of an 84-year-old woman who developed acute renal injury induced by hypersensitivity to TLV. The patient had received an implanted pacemaker and was diagnosed with exacerbation of chronic HF due to atrial fibrillation, mitral regurgitation, tricuspid regurgitation and left ventricular dyssynchrony. Treatment with tolvaptan increased the urine volume, improved the dyspnea and decreased the edema. However, the patient's renal function and hyperkalemia worsened, and the blood eosinophil count increased without signs of dehydration or hypotension. Positive findings on a drug-induced lymphocyte stimulation test for TLV were consistent with this diagnosis.
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- 2015
336. The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT
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Bahadır Kırılmaz, Semra Akgoz, Yusuf Ziya Tan, Ahmet Barutçu, Semra Ozdemir, and Fatmanur Çelik
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Male ,medicine.medical_specialty ,Gated SPECT ,Ventricular Dysfunction, Left ,Myocardial perfusion imaging ,Internal medicine ,Spect imaging ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Ventricular dyssynchrony ,Retrospective Studies ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Organotechnetium Compounds ,General Medicine ,Middle Aged ,medicine.disease ,Hypertension ,Mann–Whitney U test ,Cardiology ,Female ,Radiology ,Radiopharmaceuticals ,Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography ,business ,Perfusion ,Emission computed tomography - Abstract
Hypertension is one of the most important risk factors for cardiovascular disease. However, hypertension may also result in left ventricular dyssynchrony (LVD) which is characterized by delayed activation of certain ventricular segments leading to uncoordinated contraction. The aim of this study was to evaluate the LVD measured by phase analysis of gated single-photon emission computed tomography (SPECT) imaging in patients with hypertension. We retrospectively reviewed the records of the patients who have referred to our institution for myocardial perfusion imaging (MPI) with a diagnosis of cardiovascular disease. In this study, total of 196 patients (127 females and 69 males, with a mean age of 59.62 ± 10.27 years) with and without hypertension (123 and 73, respectively) were included. Phase analysis parameters were compared in patients with and without hypertension which are derived using Emory Cardiac Toolbox. Among these 196 patients, 72 had echocardiography results. The findings of echocardiographic and phase analysis were also compared. Student’s t test, Kruskal–Wallis, Mann–Whitney U test and Spearman correlation test were used to compare the results. There were statistically significant differences in the phase standard deviation (p = 0.005) and histogram bandwidth (p
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- 2014
337. Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction
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Husnu Degirmenci, Eftal Murat Bakirci, Şakir Arslan, Sinan Inci, Fuat Gundogdu, M. Hakan Tas, Hüseyin Şenocak, and Sule Karakelleoglu
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Chest pain ,Electrocardiography ,Ventricular Dysfunction, Left ,Percutaneous Coronary Intervention ,Internal medicine ,Humans ,Medicine ,ST segment ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Ventricular dyssynchrony ,medicine.diagnostic_test ,business.industry ,Electrocardiography in myocardial infarction ,Percutaneous coronary intervention ,Arrhythmias, Cardiac ,medicine.disease ,Cardiac Imaging Techniques ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. METHODS Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. RESULTS In the anterior MI group, basal anterior (p
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- 2014
338. Is there a right place to pace the right ventricle? Evaluation of apical and septal positions in a pacemaker population: Study protocol for a prospective intervention-control trial
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Giovanni Luca Botto, Carmine Muto, Giampiero Maglia, Gianfranco Ciaramitaro, Maurizio Malacrida, Valeria Calvi, Domenico Pecora, and Sergio Valsecchi
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Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Population ,Cardiac resynchronization therapy ,STUDY DESIGN ,Severity of Illness Index ,Internal medicine ,PACEMAKER ,medicine ,Humans ,Single-Blind Method ,Pharmacology (medical) ,Prospective Studies ,education ,Ventricular dyssynchrony ,Heart Failure ,education.field_of_study ,Ejection fraction ,DYSSYNCHRONY ,business.industry ,General Medicine ,medicine.disease ,Implantable cardioverter-defibrillator ,Hospitalization ,medicine.anatomical_structure ,Echocardiography ,Research Design ,Ventricle ,Heart failure ,Quality of Life ,Cardiology ,End-diastolic volume ,Female ,business - Abstract
Introduction The main objective of research in pacemaker therapy has been to provide the best physiologic way to pace the heart. Despite the good results provided by right ventricular pacing minimization and by biventricular pacing in specific subsets of heart failure patients, these options present many limitations for standard pacemaker recipients. In these patients, pacing the right ventricle at alternative sites could result in a lower degree of left intraventricular dyssynchrony. Despite the lack of strong evidence and the difficulty in placing and accurately classifying the final lead position, pacing at alternative right ventricular sites seems to have become a standard procedure at many implanting centers. Material and methods The RIGHT PACE study is a multi-center, prospective, single-blind, double-arm, intervention-control trial comparing right ventricular pacing from the apex and from the septal site in terms of left intraventricular dyssynchrony. A total of 408 patients with indications for cardiac pacing but without indications for ICD and/or CRT will be enrolled. Investigators will be divided on the basis of their prior experience of selective site pacing lead implantation and patients will be treated according to the clinical practice of the centers. After device implantation, they will be followed up for 24 months through evaluation of clinical, echocardiographic and safety/system-performance variables. Discussion This study might provide important information about the impact of the right ventricular pacing on the left ventricular dyssynchrony, and about acute and chronic responses to selective site pacing, as adopted in current clinical practice. This trial is registered at ClinicalTrials.gov (ID: NCT01647490 ). Trial registration Right Ventricular Lead Placement in a Pacemaker Population: Evaluation of apical and alternative position. ClinicalTrials.gov : NCT01647490 .
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- 2014
339. MitraClip in CRT non-responders with severe mitral regurgitation
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Thomas Schau, Anita Arya, Maren Schoepp, Christian Butter, Martin Seifert, and Michael Neuss
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Male ,medicine.medical_specialty ,Time Factors ,Echocardiography, Three-Dimensional ,Mean QRS Duration ,Regurgitation (circulation) ,Prosthesis Design ,Severity of Illness Index ,Cardiac Resynchronization Therapy ,Electrocardiography ,QRS complex ,Internal medicine ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Ventricular dyssynchrony ,Aged ,Retrospective Studies ,Aged, 80 and over ,Mitral regurgitation ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Stroke Volume ,Middle Aged ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Heart failure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Severe mitral regurgitation (MR) ≥3+ and left ventricular dyssynchrony in heart failure patients are markers of CRT non response. The MitraClip (MC) implantation is a therapy for MR ≥3+ in patients with high surgical risk of mitral valve reconstruction. Methods and results We investigated 42 patients with CRT and MR ≥3+ who received an MC device at our center. One and two year mortality rates were compared with the predicted mortality by Seattle Heart Failure Model (SHFM) and meta-analysis global group in chronic heart failure (MAGGIC), using the baseline characteristics of patients at the time of MC implantation. The median time interval between CRT and MC implantation was 20.1 (4.5–43.3) months. In 19 patients we observed a functional regurgitation with normal leaflets and in 23 patients a degenerative mechanism for mitral regurgitation. There was no change in mean QRS duration by biventricular pacing or MC implantation. The use of MC led to significant reductions in: median N-terminal pro-brain natriuretic peptide (NT-proBNP) level (pg/ml) from 3923 to 2636 ( p =0.02), tricuspid regurgitation pressure gradient (TRPG) from 43 to 35mmHg ( p =0.019) and in left ventricular end-diastolic volume (LVEDV) by MC ( p =0.008). At the 2year follow-up interval the all-cause mortality was 25%. Conclusion MC implantation leads to an improvement of NT-proBNP level, TRPG and LVEDV in both functional and degenerative MR but does not influence QRS duration. Two year all-cause mortality was 25% and did not differ significantly from that predicted by SHFM and MAGGIC.
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- 2014
340. QRS morphology and ventricular dyssynchrony in patients with chronic right ventricular pacing
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Kyung Hoon Cho, Woo Jin Kim, Hyun Ju Yoon, Jeong Gwan Cho, Myung Ho Jeong, Jong Chun Park, Ju Han Kim, Seung Jin Jun, Kyoung Jin Lee, Cheol Hwan Kim, Youngkeun Ahn, Min Chul Kim, Hyung Wook Park, Jae Yeong Cho, Mi Ran Kim, Doo Sun Sim, Kyung Hwan Kim, Hae Chang Jeong, Kye Hun Kim, Sung Soo Kim, Nam Sik Yoon, Hyun Kuk Kim, Ki Hong Lee, Keun-Ho Park, and Young Joon Hong
- Subjects
Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Sick sinus syndrome ,Electrocardiography ,Ventricular Dysfunction, Left ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Atrioventricular Block ,Ventricular dyssynchrony ,Aged ,Retrospective Studies ,Sick Sinus Syndrome ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,Stroke Volume ,Stroke volume ,Middle Aged ,medicine.disease ,Predictive value of tests ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block ,Follow-Up Studies - Abstract
Mechanical dyssynchrony (MD) is associated with poor outcomes in many different populations. However, the predictors for the development of MD after chronic right ventricular (RV) pacing are not well known.Pacing QRS morphology and MD using echocardiography was analyzed in 175 consecutive patients that have pacemaker implantation during a 7.6 year median follow-up. Predictive score for MD was constructed using QRS morphology variables and calculated by summing the points of the 4 variables: duration (≥150 ms, 1 point), transition (1 point), notching (2 points), and left-axis deviation (1 point), based on a multivariate-adjusted risk relationship with MD.Sixty-eight (38.9%) patients developed MD. Patients with MD had worsened left ventricular systolic function (ejection fraction from 64.6±10.6% to 59.1±10.4%, p0.001) and heart failure symptoms (New York Heart Association functional class increase from 1.1±0.3 to 1.9±0.8, p0.001). In an electrocardiographic analysis, QRS duration≥150 ms, the presence of precordial axis transition, notching, and left-axis deviation were strongly associated with MD. Predictive score for MD using QRS morphology parameters displayed an excellent graded relationship with MD (score 0: 3.4% vs. 1: 12.5% vs. 2: 22.6% vs. 3: 45.0% vs. 4: 57.9% vs. 5: 72.7%, linear p0.001) (model performance c-static 0.78, 95% confidence interval 0.72-0.85, p0.001).Patients with MD experienced a decline in left ventricular systolic function and an increase in heart failure symptoms after chronic RV pacing. A new scoring system using QRS morphology is considered a simple and efficient tool for predicting the development of MD after chronic RV pacing.
- Published
- 2014
341. Effects of long-term right ventricular apex pacing on left ventricular dyssynchrony, morphology and systolic function.
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Xin MK, Gao P, and Zhang SY
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- Case-Control Studies, Humans, Stroke Volume, Ventricular Function, Left, Cardiac Pacing, Artificial, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left therapy
- Abstract
Background: Right ventricular apex (RVA) is still the most common implanted site in the world. There are a large number of RVA pacing population who have been carrying dual-chamber permanent pacemaker (PPM) over decades. Comparison of left ventricular dyssynchrony, morphology and systolic function between RVA pacing population and healthy population is unknown., Method: This case-control study enrolled 61 patients suffered from complete atrioventricular block (III°AVB) for replacement of dual-chamber PPM. Then, 61 healthy controls matched with PPM patients in gender, age, follow-up duration and complications were included. The lead impedance, pacing threshold and sensing were compared between at implantation and long-term follow-up. Left ventricular (LV) dyssynchrony, morphology and systolic function were compared between RVA pacing population (RVA group) and healthy population (healthy group) at implantation (baseline) and follow-up. And clarify the predictors of LV systolic function in RVA group at follow-up., Results: After 112.44 ± 34.94 months of follow-up, comparing with parameters at implantation, atrial lead impedance decreased significantly (690 ± 2397 Ω vs 613 ± 2257 Ω, p = 0.048); atrial pacing threshold has a increased trend and P-wave amplitude has a decreased trend, but there was no statistical differences; while, RVA ventricular lead threshold increased significantly (0.50 ± 0.23 V vs 0.91 ± 0.47 V, p < 0.001), impedance (902 ± 397 Ω vs 680 ± 257 Ω,p < 0.001) and R-wave amplitude (11.71 ± 9.40mv vs 7.00 ± 6.91 mv, p < 0.001) decreased significantly. Compared with healthy group, long-term RVA pacing significantly increased ventricular dyssynchrony (mean QRS duration, 156.21 ± 29.80 ms vs 97.08 ± 15.70 ms, p < 0.001), left atrium diameter (LAD, 40.61 ± 6.15 mm vs 37.49 ± 4.80 mm,p = 0.002), left ventricular end-diastolic diameter (LVEDD, 49.15 ± 5.93 mm vs 46.41 ± 3.80 mm,p = 0.003), left ventricular hypertrophy (LVMI, 121.86 ± 41.52 g/m2 vs 98.41 ± 25.29 g/m2,p < 0.001), significantly deteriorated degree of tricuspid regurgitation (p < 0.001), and significantly decreased left ventricular ejection fraction (LVEF, 61.38 ± 8.10% vs 64.64 ± 5.85%, p = 0.012), but after long-term RVA pacing, the mean LVEF was still more than 50%. Long-term RVA group LVEF was negatively correlated with preimplantation LVMI (B = -0.055,t = -2.244,p = 0.029), LVMI at follow-up (B = -0.081,t = -3.864,p = 0.000) and tricuspid regurgitation at follow-up (B = -3.797,t = -3.599,p = 0.001)., Conclusion: In conclusion, although long-term RVA pacing has significantly effects on left ventricular dyssynchrony, morphology and systolic function in III°AVB patients, the mean LVEF is still >50%. High preimplantation LVMI can predict the decline of LVEF., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)
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- 2021
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342. Ventricular activation pattern assessment during right ventricular pacing: Ultra-high-frequency ECG study.
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Curila K, Jurak P, Halamek J, Prinzen F, Waldauf P, Karch J, Stros P, Plesinger F, Mizner J, Susankova M, Prochazkova R, Sussenbek O, Viscor I, Vondra V, Smisek R, Leinveber P, and Osmancik P
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- Bundle of His, Cardiac Pacing, Artificial, Electrocardiography, Humans, Myocardial Contraction, Heart Ventricles diagnostic imaging, Ventricular Septum diagnostic imaging
- Abstract
Background: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra-high-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations., Methods: In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay)., Results: The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them., Conclusion: RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch., (© 2021 Wiley Periodicals LLC.)
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- 2021
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343. Conduction System Pacing for Cardiac Resynchronisation.
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Sharma PS and Vijayaraman P
- Abstract
Conduction system pacing (CSP) is a technique of pacing that involves implantation of permanent pacing leads along different sites of the cardiac conduction system and includes His bundle pacing and left bundle branch pacing. There is an emerging role for CSP to achieve cardiac resynchronisation in patients with heart failure with reduced ejection fraction and inter-ventricular dyssynchrony. In this article, the authors review these strategies for resynchronisation and the available data on the use of CSP in overcoming dyssynchrony., Competing Interests: Disclosure: PSS has received honoraria from Medtronic and is a consultant for Abbott, Biotronik, Boston Scientific and Medtronic; PV has received honoraria and does research for Medtronic, and is a consultant for Abbott, Biotronik, Boston Scientific and Medtronic and has patented a His bundle pacing delivery tool., (Copyright © 2021, Radcliffe Cardiology.)
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- 2021
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344. Effect of activating intrinsic conduction search on left ventricular dyssynchrony in patients with conventional pacemaker
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Leonor Garcia Rincon, Maria do Carmo Pereira Nunes, Marco Túlio Baccarini Pires, and Manoel Otávio da Costa Rocha
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Ventricular dyssynchrony ,Lead (electronics) ,Aged ,Ventricular function ,business.industry ,Cardiac Pacing, Artificial ,Stroke Volume ,Ultrasonography, Doppler ,Stroke volume ,Middle Aged ,Ventricular pacing ,medicine.disease ,Echocardiography ,Heart failure ,Cardiology ,Female ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Rightventricular(RV)apicalpacingcreatesanabnormalventricularactivation pattern inducing cardiac dyssynchrony, ventricular dysfunc-tion,andanincreasedmortalityrisk[1–3].Atrial-basedpacingtomain-tainatrioventricular(AV)synchronycandecreasetheincidenceofatrialfibrillation (AF), heart failure and overall mortality rates [1]. However,evenwhenAV-nodefunctionispreserved,dual-chamber(DDD)pacingoften results in frequent ventricular pacing [3]. Previous analyses linkthefrequencyofRVpacedbeatstoincreasedrisksofAFandheartfailurein patients with sinus-node disease [4].To overcome the limitations of pacing-induced asynchronouselectricalactivation,devicealgorithmshavebeendevelopedtopromotenormal AV synchrony by preserving the physiologic ventricular activa-tion sequence [2].Specifically, intrinsic conduction search (ICS) hasbeen shown to lead to a decrease in unnecessary RV pacing and itsadverse consequences on left ventricular function [5,6].Moreover,pulsegeneratorlongevityisanimportant issueinthecareof pacemaker patients [7]. One of the determinants of pacemaker lon-gevityisthe energy consumption ofthepulsegenerator,whichdependson programmable variables, including output parameters of the system(voltage and pulse width), and the frequency and percentage of pacing.A previous study using an algorithm to preserve normal AV synchrony
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- 2016
345. 2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function: a case-control study
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Ryan Hubbard, Joyce A. Kukuzke, Maria C. Arciniegas Calle, Sergio Barros-Gomes, Hector R. Villarraga, Patricia A. Pellikka, and Rajiv Gulati
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lcsh:Diseases of the circulatory (Cardiovascular) system ,Speckle tracking echocardiography ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Ventricular Function, Left ,Coronary artery disease ,0302 clinical medicine ,Normal ejection fraction ,030212 general & internal medicine ,Ejection fraction ,Area under the curve ,Stroke volume ,Middle Aged ,Biomechanical Phenomena ,2D-STE ,Echocardiography ,Area Under Curve ,Predictive value of tests ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Research Article ,Adult ,medicine.medical_specialty ,Young Adult ,03 medical and health sciences ,Sex Factors ,Predictive Value of Tests ,Coronary artery disease in women ,Internal medicine ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Ventricular dyssynchrony ,Aged ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,Coronary Stenosis ,Reproducibility of Results ,Stroke Volume ,medicine.disease ,Myocardial Contraction ,Dyssynchrony ,ROC Curve ,lcsh:RC666-701 ,Feasibility Studies ,Stress, Mechanical ,business - Abstract
Background Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (−19.4% vs −22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s−1 vs 1.9 s−1, P = .05); global longitudinal LV S (GLS) (−14.3% vs −17.2%, P
- Published
- 2017
346. Successful Catheter Ablation as a Substitute for Cardiac Resynchronization Therapy in Patient with an Accessory Pathway-induced Cardiomyopathy
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Masayuki Goto, Ryo Sugiura, Daichi Isomura, Naomi Kawakatsu, Hideki Saito, Toshiaki Suzuki, Keisuke Nakabayashi, Naomi Nakazawa, Hisayuki Okada, Yusuke Mizuno, Hiroko Kato, and Toshiaki Oka
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Cardiac function curve ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Bundle-Branch Block ,Cardiac resynchronization therapy ,Cardiomyopathy ,Catheter ablation ,Case Report ,radiofrequency catheter ablation ,Accessory pathway ,030204 cardiovascular system & hematology ,accessory pathway-induced cardiomyopathy ,Cardiac Resynchronization Therapy ,Diagnosis, Differential ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Ventricular dyssynchrony ,right-sided pre-excitation syndrome ,Heart Failure ,Left bundle branch block ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Echocardiography ,Heart failure ,Cardiology ,cardiovascular system ,Catheter Ablation ,Wolff-Parkinson-White Syndrome ,business - Abstract
A 50-year-old man presented with exertional dyspnea and orthopnea. An electrocardiogram showed a delta wave and a wide QRS complex, similar to left bundle branch block. Cardiac echocardiography revealed diffuse severe hypokinesis and dyssynchrony. The patient was diagnosed with congestive heart failure. We considered that the patient's condition was caused by an accessory pathway-induced cardiomyopathy after heart failure compensation with guideline-oriented medical therapy. We therefore performed catheter ablation for right-sided pre-excitation syndrome as cardiac resynchronization therapy. The left ventricular dyssynchrony was resolved immediately after the procedure, and the patient's ventricular contraction improved, with a reduced cardiac volume at 6 months after the procedure-thus suggesting that the accessory pathway had affected the patient's cardiac function.
- Published
- 2017
347. Correlation of left ventricular dyssynchrony on gated myocardial perfusion SPECT analysis with extent of late gadolinium enhancement on cardiac magnetic resonance imaging in hypertrophic cardiomyopathy
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Masafumi Kidoh, Seitaro Oda, Takeshi Nakaura, Shinya Shiraishi, Noriko Tsuda, Daisuke Utsunomiya, Fumi Sakamoto, Kenichi Tsujita, Hideaki Yuki, Yasuyuki Yamashita, and Seiji Takashio
- Subjects
Adult ,Gadolinium DTPA ,Male ,medicine.medical_specialty ,Heart Ventricles ,Contrast Media ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Single-photon emission computed tomography ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Ventricular dyssynchrony ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Hypertrophic cardiomyopathy ,Magnetic resonance imaging ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Emission computed tomography - Abstract
Myocardial perfusion-single-photon emission computed tomography (MP-SPECT) is used to evaluate microvascular dysfunction and coexisting coronary artery disease in patients with hypertrophic cardiomyopathy (HCM). Phase analysis in gated MP-SPECT can provide additional information on left ventricular (LV) dyssynchrony, while the extent of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging is an important prognostic factor in patients with HCM. We, therefore, sought to investigate the relationship of dyssynchrony by phase analysis on gated MP-SPECT and LGE on CMR imaging in 22 patients with HCM who underwent both stress/rest-gated MP-SPECT and contrast-enhanced CMR imaging. LV dyssynchrony parameters [phase standard deviation (SD) and histogram bandwidth] from gated MP-SPECT were compared with LGE parameters from CMR imaging [L/C contrast and %LGE calculated, respectively, as LGE intensity/LV cavity intensity and (LGE volume/myocardial volume) × 100]. Phase SD and histogram bandwidth showed strong correlation with %LGE (r = 0.73, p
- Published
- 2017
348. 3866Quantitative intraventricular hemodynamic forces: a sensitive and specific marker of left ventricular dyssynchrony
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Håkan Arheden, Rasmus Borgquist, M Carlsson, Per M. Arvidsson, Gianni Pedrizzetti, Einar Heiberg, and Johannes Töger
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medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,Ventricular dyssynchrony ,medicine.disease ,business ,Hemodynamic forces - Published
- 2017
349. P1676Global longitudinal strain improve prediction of right ventricular pacing induced left ventricular dyssynchrony in patients with permanent pacemaker
- Author
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W.D. Bang, S.Y. Yoo, Yeo-Jeong Song, S.S. Cheong, S.J. Ha, and W.K. Lee
- Subjects
medicine.medical_specialty ,Longitudinal strain ,business.industry ,030204 cardiovascular system & hematology ,Ventricular pacing ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cardiology ,Medicine ,In patient ,030212 general & internal medicine ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business ,Ventricular dyssynchrony - Published
- 2017
350. P5298Novel ECG-based measure of ventricular dyssynchrony and its evaluation in MADIT-CRT patients with left bundle branch block
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Pavel Leinveber, Jean-Philippe Couderc, Wojciech Zareba, Scott McNitt, Vlastimil Vondra, Arthur J. Moss, Josef Halamek, Filip Plesinger, Ivo Viscor, and Pavel Jurák
- Subjects
medicine.medical_specialty ,business.industry ,Left bundle branch block ,Internal medicine ,medicine ,Measure (physics) ,Cardiology ,Madit crt ,Cardiology and Cardiovascular Medicine ,Ventricular dyssynchrony ,medicine.disease ,business - Published
- 2017
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