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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy
Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Netherlands
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255256/ https://www.ncbi.nlm.nih.gov/pubmed/33547623 http://dx.doi.org/10.1007/s10554-021-02174-7 |
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author | Wouters, Philippe C. Leenders, Geert E. Cramer, Maarten J. Meine, Mathias Prinzen, Frits W. Doevendans, Pieter A. De Boeck, Bart W. L. |
author_facet | Wouters, Philippe C. Leenders, Geert E. Cramer, Maarten J. Meine, Mathias Prinzen, Frits W. Doevendans, Pieter A. De Boeck, Bart W. L. |
author_sort | Wouters, Philippe C. |
collection | PubMed |
description | Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dt(max,)) during CRT-implantation. The acute change in dP/dt(max), LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dt(max) 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10554-021-02174-7. |
format | Online Article Text |
id | pubmed-8255256 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Netherlands |
record_format | MEDLINE/PubMed |
spelling | pubmed-82552562021-07-20 Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy Wouters, Philippe C. Leenders, Geert E. Cramer, Maarten J. Meine, Mathias Prinzen, Frits W. Doevendans, Pieter A. De Boeck, Bart W. L. Int J Cardiovasc Imaging Original Paper Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dt(max,)) during CRT-implantation. The acute change in dP/dt(max), LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dt(max) 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10554-021-02174-7. Springer Netherlands 2021-02-05 2021 /pmc/articles/PMC8255256/ /pubmed/33547623 http://dx.doi.org/10.1007/s10554-021-02174-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Paper Wouters, Philippe C. Leenders, Geert E. Cramer, Maarten J. Meine, Mathias Prinzen, Frits W. Doevendans, Pieter A. De Boeck, Bart W. L. Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title | Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title_full | Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title_fullStr | Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title_full_unstemmed | Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title_short | Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
title_sort | acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255256/ https://www.ncbi.nlm.nih.gov/pubmed/33547623 http://dx.doi.org/10.1007/s10554-021-02174-7 |
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