Intramural dyssynchrony and response to cardiac resynchronization therapy in patients with and without previous right ventricular pacing

Alan J. Bank, Christopher L. Kaufman, Kevin V. Burns, Joshua S. Parah, Lauren Johnson, Aaron S Kelly, Sanjeev G. Shroff, Daniel R. Kaiser

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Aims Right ventricular (RV) pacing is an iatrogenic cause of heart failure (HF) that has not been well studied. We assessed whether HF patients paced from the right ventricle (RVp) adversely remodel and respond to cardiac resynchronization therapy (CRT) in a similar way to HF patients without right ventricular pacing (nRVp). Methods and results Echocardiograms were performed before and ∼5 months after CRT in 31 RVp and 49 nRVp HF patients. Longitudinal intraventricular dyssynchrony using tissue Doppler imaging (TDI) was calculated as the standard deviation of time to peak systolic displacement by tissue tracking (SD-TT) of 12 segments. Longitudinal dyssynchrony within a wall (intramural dyssynchrony) was assessed by two methods: quantifying the number of segments with initial abnormal apical displacement (IMD score) and using a cross-correlation synchrony index (CCSI). Despite similar ejection fractions (EFs) of 28 prior to CRT, left ventricular end-diastolic volume was significantly smaller (143 ± 54 vs. 183 ± 62, P = 0.004) in RVp. The standard deviation of time to peak systolic displacement by tissue tracking (83.4 ± 34.9 vs. 67.9 ± 26.6, P = 0.03) and IMD score (3.1 ± 1.8 vs. 1.3 ± 1.7, P < 0.001) were greater in RVp. Cardiac resynchronization therapy significantly improved EF and volumes in both groups. Ejection fraction increased more in RVp (12.8 ± 9.2 vs. 7.4 ± 7.6, P = 0.007). Intraventricular dyssynchrony and both measures of intramural septal dyssynchrony improved to a greater extent post-CRT in RVp.Conclusion Right ventricular pacing patients differ from nRVp HF patients in that they have smaller ventricles and greater intraventricular and intramural septal dyssynchrony. Right ventricular pacing HF patients respond better to CRT with greater improvements in EF, and intraventricular and intramural septal dyssynchrony.

Original languageEnglish (US)
Pages (from-to)1317-1324
Number of pages8
JournalEuropean Journal of Heart Failure
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2010

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Cardiac Resynchronization Therapy
Heart Failure
Patient Rights
Stroke Volume
Heart Ventricles

Keywords

  • Cardiac mechanics
  • Echocardiography
  • Heart failure
  • Pacing
  • Tissue Doppler imaging

Cite this

Intramural dyssynchrony and response to cardiac resynchronization therapy in patients with and without previous right ventricular pacing. / Bank, Alan J.; Kaufman, Christopher L.; Burns, Kevin V.; Parah, Joshua S.; Johnson, Lauren; Kelly, Aaron S; Shroff, Sanjeev G.; Kaiser, Daniel R.

In: European Journal of Heart Failure, Vol. 12, No. 12, 01.12.2010, p. 1317-1324.

Research output: Contribution to journalArticle

Bank, Alan J. ; Kaufman, Christopher L. ; Burns, Kevin V. ; Parah, Joshua S. ; Johnson, Lauren ; Kelly, Aaron S ; Shroff, Sanjeev G. ; Kaiser, Daniel R. / Intramural dyssynchrony and response to cardiac resynchronization therapy in patients with and without previous right ventricular pacing. In: European Journal of Heart Failure. 2010 ; Vol. 12, No. 12. pp. 1317-1324.
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abstract = "Aims Right ventricular (RV) pacing is an iatrogenic cause of heart failure (HF) that has not been well studied. We assessed whether HF patients paced from the right ventricle (RVp) adversely remodel and respond to cardiac resynchronization therapy (CRT) in a similar way to HF patients without right ventricular pacing (nRVp). Methods and results Echocardiograms were performed before and ∼5 months after CRT in 31 RVp and 49 nRVp HF patients. Longitudinal intraventricular dyssynchrony using tissue Doppler imaging (TDI) was calculated as the standard deviation of time to peak systolic displacement by tissue tracking (SD-TT) of 12 segments. Longitudinal dyssynchrony within a wall (intramural dyssynchrony) was assessed by two methods: quantifying the number of segments with initial abnormal apical displacement (IMD score) and using a cross-correlation synchrony index (CCSI). Despite similar ejection fractions (EFs) of 28 prior to CRT, left ventricular end-diastolic volume was significantly smaller (143 ± 54 vs. 183 ± 62, P = 0.004) in RVp. The standard deviation of time to peak systolic displacement by tissue tracking (83.4 ± 34.9 vs. 67.9 ± 26.6, P = 0.03) and IMD score (3.1 ± 1.8 vs. 1.3 ± 1.7, P < 0.001) were greater in RVp. Cardiac resynchronization therapy significantly improved EF and volumes in both groups. Ejection fraction increased more in RVp (12.8 ± 9.2 vs. 7.4 ± 7.6, P = 0.007). Intraventricular dyssynchrony and both measures of intramural septal dyssynchrony improved to a greater extent post-CRT in RVp.Conclusion Right ventricular pacing patients differ from nRVp HF patients in that they have smaller ventricles and greater intraventricular and intramural septal dyssynchrony. Right ventricular pacing HF patients respond better to CRT with greater improvements in EF, and intraventricular and intramural septal dyssynchrony.",
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T1 - Intramural dyssynchrony and response to cardiac resynchronization therapy in patients with and without previous right ventricular pacing

AU - Bank, Alan J.

AU - Kaufman, Christopher L.

AU - Burns, Kevin V.

AU - Parah, Joshua S.

AU - Johnson, Lauren

AU - Kelly, Aaron S

AU - Shroff, Sanjeev G.

AU - Kaiser, Daniel R.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Aims Right ventricular (RV) pacing is an iatrogenic cause of heart failure (HF) that has not been well studied. We assessed whether HF patients paced from the right ventricle (RVp) adversely remodel and respond to cardiac resynchronization therapy (CRT) in a similar way to HF patients without right ventricular pacing (nRVp). Methods and results Echocardiograms were performed before and ∼5 months after CRT in 31 RVp and 49 nRVp HF patients. Longitudinal intraventricular dyssynchrony using tissue Doppler imaging (TDI) was calculated as the standard deviation of time to peak systolic displacement by tissue tracking (SD-TT) of 12 segments. Longitudinal dyssynchrony within a wall (intramural dyssynchrony) was assessed by two methods: quantifying the number of segments with initial abnormal apical displacement (IMD score) and using a cross-correlation synchrony index (CCSI). Despite similar ejection fractions (EFs) of 28 prior to CRT, left ventricular end-diastolic volume was significantly smaller (143 ± 54 vs. 183 ± 62, P = 0.004) in RVp. The standard deviation of time to peak systolic displacement by tissue tracking (83.4 ± 34.9 vs. 67.9 ± 26.6, P = 0.03) and IMD score (3.1 ± 1.8 vs. 1.3 ± 1.7, P < 0.001) were greater in RVp. Cardiac resynchronization therapy significantly improved EF and volumes in both groups. Ejection fraction increased more in RVp (12.8 ± 9.2 vs. 7.4 ± 7.6, P = 0.007). Intraventricular dyssynchrony and both measures of intramural septal dyssynchrony improved to a greater extent post-CRT in RVp.Conclusion Right ventricular pacing patients differ from nRVp HF patients in that they have smaller ventricles and greater intraventricular and intramural septal dyssynchrony. Right ventricular pacing HF patients respond better to CRT with greater improvements in EF, and intraventricular and intramural septal dyssynchrony.

AB - Aims Right ventricular (RV) pacing is an iatrogenic cause of heart failure (HF) that has not been well studied. We assessed whether HF patients paced from the right ventricle (RVp) adversely remodel and respond to cardiac resynchronization therapy (CRT) in a similar way to HF patients without right ventricular pacing (nRVp). Methods and results Echocardiograms were performed before and ∼5 months after CRT in 31 RVp and 49 nRVp HF patients. Longitudinal intraventricular dyssynchrony using tissue Doppler imaging (TDI) was calculated as the standard deviation of time to peak systolic displacement by tissue tracking (SD-TT) of 12 segments. Longitudinal dyssynchrony within a wall (intramural dyssynchrony) was assessed by two methods: quantifying the number of segments with initial abnormal apical displacement (IMD score) and using a cross-correlation synchrony index (CCSI). Despite similar ejection fractions (EFs) of 28 prior to CRT, left ventricular end-diastolic volume was significantly smaller (143 ± 54 vs. 183 ± 62, P = 0.004) in RVp. The standard deviation of time to peak systolic displacement by tissue tracking (83.4 ± 34.9 vs. 67.9 ± 26.6, P = 0.03) and IMD score (3.1 ± 1.8 vs. 1.3 ± 1.7, P < 0.001) were greater in RVp. Cardiac resynchronization therapy significantly improved EF and volumes in both groups. Ejection fraction increased more in RVp (12.8 ± 9.2 vs. 7.4 ± 7.6, P = 0.007). Intraventricular dyssynchrony and both measures of intramural septal dyssynchrony improved to a greater extent post-CRT in RVp.Conclusion Right ventricular pacing patients differ from nRVp HF patients in that they have smaller ventricles and greater intraventricular and intramural septal dyssynchrony. Right ventricular pacing HF patients respond better to CRT with greater improvements in EF, and intraventricular and intramural septal dyssynchrony.

KW - Cardiac mechanics

KW - Echocardiography

KW - Heart failure

KW - Pacing

KW - Tissue Doppler imaging

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