Effect of low-amplitude two-dimensional radial strain at left ventricular pacing sites on response to cardiac resynchronization therapy
| Autor: | Michael T. Fahey, Maros Elsik, Munmohan Virdee, Peter J. Pugh, Fakhar Z. Khan, David P. Dutka, Philip A. Read, Simon P. Fynn, David Begley, Denis O’Halloran |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Pacemaker Artificial Time Factors medicine.medical_treatment Cardiac resynchronization therapy Risk Assessment Severity of Illness Index Cardiac Resynchronization Therapy Cohort Studies Ventricular Dysfunction Left Sex Factors Internal medicine medicine Confidence Intervals Odds Ratio Cutoff Humans Radiology Nuclear Medicine and imaging Derivation Survival rate Aged Aged 80 and over Ventricular Remodeling business.industry Age Factors Stroke Volume Middle Aged medicine.disease Myocardial Contraction Confidence interval Survival Rate Treatment Outcome Echocardiography Heart failure Cardiology Linear Models Female Cardiology and Cardiovascular Medicine Lead Placement business Radial stress Follow-Up Studies |
| Zdroj: | Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 23(11) |
| ISSN: | 1097-6795 |
| Popis: | Left ventricular (LV) lead placement to areas of scar has detrimental effects on response to cardiac resynchronization therapy (CRT). Speckle-tracking radial two-dimensional strain offers assessment of the extent of regional myocardial deformation. The aim of this study was to assess the impact of LV lead placement at areas of low-amplitude strain on CRT response.The optimal cutoff of radial strain amplitude at the LV pacing site associated with an unfavorable CRT response was determined in a derivation group (n = 65) and then tested in a second consecutive validation group (n = 75) of patients with heart failure. Patients had concordant LV leads if placed at the most delayed site, and dyssynchrony was defined as anteroseptal to posterior delay ≥ 130 msec. CRT response was defined as a ≥15% reduction in LV end-systolic volume at 6 months.In the derivation group, a derived cutoff for radial strain amplitude of9.8% defined low-amplitude segments (LAS) and had a high specificity but low sensitivity for predicting LV reverse remodeling, suggesting a strong negative predictive value. In the validation group, compared with patients without LAS at the LV pacing site, in patients with LAS (n = 16), CRT response was significantly lower (62.7% vs 31.3%, P.05). By multivariate analysis, LV lead concordance and the absence of an LAS at the LV pacing site but not dyssynchrony were significantly related to CRT response.LV lead placement over segments with two-dimensional radial strain amplitudes9.8% is associated with poor outcomes of CRT. |
| Databáze: | OpenAIRE |
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