TY - JOUR
T1 - Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist
AU - Bertini, Matteo
AU - Marsan, Nina Ajmone
AU - Delgado, Victoria
AU - van Bommel, Rutger J.
AU - Nucifora, Gaetano
AU - Borleffs, C. Jan Willem
AU - Boriani, Giuseppe
AU - Biffi, Mauro
AU - Holman, Eduard R.
AU - van der Wall, Ernst E.
AU - Schalij, Martin J.
AU - Bax, Jeroen J.
N1 - Funding Information:
Drs. Ajmone Marsan and Delgado are supported by a research grant from the European Society of Cardiology. Dr. Nucifora is supported by a research grant from the European Association of Percutaneous Cardiovascular Interventions. Dr. Schalij has received grants from Biotronik, Medtronic, and Boston Scientific. Dr. Bax has received grants from Medtronic, Boston Scientific, Biotronik, St. Jude Medical, Bristol-Myers Squibb Medical Imaging, Edwards Lifesciences, and GE Healthcare. Richard A. Grimm, DO, served as Guest Editor for this article.
PY - 2009/9/29
Y1 - 2009/9/29
N2 - Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15% at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.
AB - Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15% at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.
KW - cardiac resynchronization therapy
KW - heart failure
KW - left ventricular lead position
KW - left ventricular reverse remodeling
KW - left ventricular twist
UR - https://www.scopus.com/pages/publications/70349177513
U2 - 10.1016/j.jacc.2009.05.063
DO - 10.1016/j.jacc.2009.05.063
M3 - Article
C2 - 19778675
AN - SCOPUS:70349177513
SN - 0735-1097
VL - 54
SP - 1317
EP - 1325
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 14
ER -