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Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy

AIMS: Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. METHODS AND RESULTS: Sixty-two patients were prospectively enro...

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Autores principales: Maffessanti, Francesco, Jadczyk, Tomasz, Wilczek, Jacek, Conte, Giulio, Caputo, Maria Luce, Gołba, Krzysztof S, Biernat, Jolanta, Cybulska, Magdalena, Caluori, Guido, Regoli, François, Krause, Rolf, Wojakowski, Wojciech, Prinzen, Frits W, Auricchio, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935025/
https://www.ncbi.nlm.nih.gov/pubmed/36106562
http://dx.doi.org/10.1093/europace/euac157
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author Maffessanti, Francesco
Jadczyk, Tomasz
Wilczek, Jacek
Conte, Giulio
Caputo, Maria Luce
Gołba, Krzysztof S
Biernat, Jolanta
Cybulska, Magdalena
Caluori, Guido
Regoli, François
Krause, Rolf
Wojakowski, Wojciech
Prinzen, Frits W
Auricchio, Angelo
author_facet Maffessanti, Francesco
Jadczyk, Tomasz
Wilczek, Jacek
Conte, Giulio
Caputo, Maria Luce
Gołba, Krzysztof S
Biernat, Jolanta
Cybulska, Magdalena
Caluori, Guido
Regoli, François
Krause, Rolf
Wojakowski, Wojciech
Prinzen, Frits W
Auricchio, Angelo
author_sort Maffessanti, Francesco
collection PubMed
description AIMS: Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. METHODS AND RESULTS: Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead electrocardiogram (ECG), cardiovascular magnetic resonance (CMR), echocardiography, and anatomo-electromechanical mapping (AEMM). Remodelling was measured as the end-systolic volume (ΔESV) decrease at 6 months. CRT was defined effective with ΔESV ≤ −15%. QRS duration (QRSd) was measured from ECG. Area strain was obtained from AEMM and used to derive systolic stretch index (SSI) and total left-ventricular mechanical time. Total left-ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar was measured from CMR. Significant correlations were observed between ΔESV and TST [rho = 0.42; responder: 50 (20–58) vs. non-responder: 33 (8–44) ms], TLVAT [−0.68; 81 (73–97) vs. 112 (96–127) ms], scar [−0.27; 0.0 (0.0–1.2) vs. 8.7 (0.0–19.1)%], and SSI [0.41; 10.7 (7.1–16.8) vs. 4.2 (2.9–5.5)], but not QRSd [−0.13; 155 (140–176) vs. 167 (155–177) ms]. TLVAT and SSI were highly accurate in identifying CRT response [area under the curve (AUC) > 0.80], followed by scar (AUC > 0.70). Total left-ventricular activation time (odds ratio = 0.91), scar (0.94), and SSI (1.29) were independent factors associated with effective CRT. Subjects with SSI >7.9% and TLVAT <91 ms all responded to CRT with a median ΔESV ≈ −50%, while low SSI and prolonged TLVAT were more common in non-responders (ΔESV ≈ −5%). CONCLUSION: Electromechanical measurements are better associated with CRT response than conventional ECG variables. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.
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spelling pubmed-99350252023-02-17 Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy Maffessanti, Francesco Jadczyk, Tomasz Wilczek, Jacek Conte, Giulio Caputo, Maria Luce Gołba, Krzysztof S Biernat, Jolanta Cybulska, Magdalena Caluori, Guido Regoli, François Krause, Rolf Wojakowski, Wojciech Prinzen, Frits W Auricchio, Angelo Europace Clinical Research AIMS: Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. METHODS AND RESULTS: Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead electrocardiogram (ECG), cardiovascular magnetic resonance (CMR), echocardiography, and anatomo-electromechanical mapping (AEMM). Remodelling was measured as the end-systolic volume (ΔESV) decrease at 6 months. CRT was defined effective with ΔESV ≤ −15%. QRS duration (QRSd) was measured from ECG. Area strain was obtained from AEMM and used to derive systolic stretch index (SSI) and total left-ventricular mechanical time. Total left-ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar was measured from CMR. Significant correlations were observed between ΔESV and TST [rho = 0.42; responder: 50 (20–58) vs. non-responder: 33 (8–44) ms], TLVAT [−0.68; 81 (73–97) vs. 112 (96–127) ms], scar [−0.27; 0.0 (0.0–1.2) vs. 8.7 (0.0–19.1)%], and SSI [0.41; 10.7 (7.1–16.8) vs. 4.2 (2.9–5.5)], but not QRSd [−0.13; 155 (140–176) vs. 167 (155–177) ms]. TLVAT and SSI were highly accurate in identifying CRT response [area under the curve (AUC) > 0.80], followed by scar (AUC > 0.70). Total left-ventricular activation time (odds ratio = 0.91), scar (0.94), and SSI (1.29) were independent factors associated with effective CRT. Subjects with SSI >7.9% and TLVAT <91 ms all responded to CRT with a median ΔESV ≈ −50%, while low SSI and prolonged TLVAT were more common in non-responders (ΔESV ≈ −5%). CONCLUSION: Electromechanical measurements are better associated with CRT response than conventional ECG variables. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT. Oxford University Press 2022-09-15 /pmc/articles/PMC9935025/ /pubmed/36106562 http://dx.doi.org/10.1093/europace/euac157 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Maffessanti, Francesco
Jadczyk, Tomasz
Wilczek, Jacek
Conte, Giulio
Caputo, Maria Luce
Gołba, Krzysztof S
Biernat, Jolanta
Cybulska, Magdalena
Caluori, Guido
Regoli, François
Krause, Rolf
Wojakowski, Wojciech
Prinzen, Frits W
Auricchio, Angelo
Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title_full Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title_fullStr Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title_full_unstemmed Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title_short Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
title_sort electromechanical factors associated with favourable outcome in cardiac resynchronization therapy
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935025/
https://www.ncbi.nlm.nih.gov/pubmed/36106562
http://dx.doi.org/10.1093/europace/euac157
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