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Erschienen in: The International Journal of Cardiovascular Imaging 6/2017

01.02.2017 | Original Paper

Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy

verfasst von: Chun-Li Wang, Chia-Tung Wu, Yung-Hsin Yeh, Lung-Sheng Wu, Yi-Hsin Chan, Chi-Tai Kuo, Pao-Hsien Chu, Lung-An Hsu, Wan-Jing Ho

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 6/2017

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Abstract

A left bundle-branch block (LBBB) contraction pattern identified from longitudinal-strain analysis predicts outcomes following cardiac resynchronization therapy (CRT). We investigated the use of an LBBB-contraction pattern identified from radial- or circumferential-strain analysis in the prediction of CRT benefits. Eighty CRT candidates were prospectively enrolled. Before CRT implantation, speckle-tracking analyses in three deformation directions were performed to determine whether an LBBB-contraction pattern was present. The study endpoints were reverse remodeling at 6 months, and adverse outcomes including death or heart failure hospitalization. At 6 months, 49 (61%) patients had reverse remodeling. An LBBB-contraction pattern identified from the radial strain in the mid-ventricular short-axis view or longitudinal strain in the four-chamber view provided excellent true-positive (86%) and false-negative (8%) rates for predicting reverse remodeling. During a median follow-up of 30 months, 31 patients (39%) had adverse outcomes. Absence of an LBBB-contraction pattern in radial (hazard ratio 3.74; 95% confidence interval 1.83–7.62) or longitudinal strain (hazard ratio 3.49; 95% confidence interval 1.71–7.13) was significantly associated with an increased risk of adverse outcomes. Adding the LBBB-pattern assessment by radial-(model χ2 from 8.2 to 18.5, p = 0.005), or longitudinal-strain analysis (model χ2 from 8.2 to 16.9, p = 0.011) to a risk model significantly improved the model, including QRS duration and ischemic etiology. In conclusion, an LBBB-contraction pattern identified from radial-strain analysis in the mid-ventricular short-axis view predicted reverse remodeling and outcome following CRT, similarly to the longitudinal-strain analysis.
Literatur
1.
Zurück zum Zitat Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150CrossRefPubMed Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150CrossRefPubMed
2.
Zurück zum Zitat Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NA 3rd, Foster E, Greenberg H, Higgins SL, Pfeffer MA, Solomon SD, Wilber D, Zareba W (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361(14):1329–1338CrossRefPubMed Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NA 3rd, Foster E, Greenberg H, Higgins SL, Pfeffer MA, Solomon SD, Wilber D, Zareba W (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361(14):1329–1338CrossRefPubMed
3.
Zurück zum Zitat Dupont M, Rickard J, Baranowski B, Varma N, Dresing T, Gabi A, Finucan M, Mullens W, Wilkoff BL, Tang WH (2012) Differential response to cardiac resynchronization therapy and clinical outcomes according to QRS morphology and QRS duration. J Am Coll Cardiol 60(7):592–598CrossRefPubMed Dupont M, Rickard J, Baranowski B, Varma N, Dresing T, Gabi A, Finucan M, Mullens W, Wilkoff BL, Tang WH (2012) Differential response to cardiac resynchronization therapy and clinical outcomes according to QRS morphology and QRS duration. J Am Coll Cardiol 60(7):592–598CrossRefPubMed
4.
Zurück zum Zitat Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M, Cannom D, Daubert JP, Eldar M, Gold MR, Goldberger JJ, Goldenberg I, Lichstein E, Pitschner H, Rashtian M, Solomon S, Viskin S, Wang P, Moss AJ (2011) Effectiveness of cardiac resynchronization therapy by QRS morphology in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT). Circulation 123(10):1061–1072CrossRefPubMed Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M, Cannom D, Daubert JP, Eldar M, Gold MR, Goldberger JJ, Goldenberg I, Lichstein E, Pitschner H, Rashtian M, Solomon S, Viskin S, Wang P, Moss AJ (2011) Effectiveness of cardiac resynchronization therapy by QRS morphology in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT). Circulation 123(10):1061–1072CrossRefPubMed
5.
Zurück zum Zitat Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, Kloss M, Klein H (2004) Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation 109(9):1133–1139CrossRefPubMed Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, Kloss M, Klein H (2004) Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation 109(9):1133–1139CrossRefPubMed
6.
Zurück zum Zitat Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG (2013) Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace 15(12):1816–1821CrossRefPubMed Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG (2013) Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace 15(12):1816–1821CrossRefPubMed
7.
Zurück zum Zitat Risum N, Jons C, Olsen NT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Valeur N, Kronborg MB, Kisslo J, Sogaard P (2012) Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages. Am Heart J 163(4):697–704CrossRefPubMed Risum N, Jons C, Olsen NT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Valeur N, Kronborg MB, Kisslo J, Sogaard P (2012) Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages. Am Heart J 163(4):697–704CrossRefPubMed
8.
Zurück zum Zitat Risum N, Tayal B, Hansen TF, Bruun NE, Jensen MT, Lauridsen TK, Saba S, Kisslo J, Gorcsan J 3rd, Sogaard P (2015) Identification of typical left bundle branch block contraction by strain echocardiography is additive to electrocardiography in prediction of long-term outcome after cardiac resynchronization therapy. J Am Coll Cardiol 66(6):631–641CrossRefPubMed Risum N, Tayal B, Hansen TF, Bruun NE, Jensen MT, Lauridsen TK, Saba S, Kisslo J, Gorcsan J 3rd, Sogaard P (2015) Identification of typical left bundle branch block contraction by strain echocardiography is additive to electrocardiography in prediction of long-term outcome after cardiac resynchronization therapy. J Am Coll Cardiol 66(6):631–641CrossRefPubMed
9.
Zurück zum Zitat Leenders GE, Lumens J, Cramer MJ, De Boeck BW, Doevendans PA, Delhaas T, Prinzen FW (2012) Septal deformation patterns delineate mechanical dyssynchrony and regional differences in contractility: analysis of patient data using a computer model. Circ Heart Fail 5(1):87–96CrossRefPubMed Leenders GE, Lumens J, Cramer MJ, De Boeck BW, Doevendans PA, Delhaas T, Prinzen FW (2012) Septal deformation patterns delineate mechanical dyssynchrony and regional differences in contractility: analysis of patient data using a computer model. Circ Heart Fail 5(1):87–96CrossRefPubMed
10.
Zurück zum Zitat Gorcsan J 3rd, Abraham T, Agler DA, Bax JJ, Derumeaux G, Grimm RA, Martin R, Steinberg JS, Sutton MS, Yu CM (2008) Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting: a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr 21(3):191–213CrossRefPubMed Gorcsan J 3rd, Abraham T, Agler DA, Bax JJ, Derumeaux G, Grimm RA, Martin R, Steinberg JS, Sutton MS, Yu CM (2008) Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting: a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr 21(3):191–213CrossRefPubMed
11.
Zurück zum Zitat Fung JW, Yu CM, Yip G, Zhang Y, Chan H, Kum CC, Sanderson JE (2004) Variable left ventricular activation pattern in patients with heart failure and left bundle branch block. Heart 90(1):17–19CrossRefPubMedPubMedCentral Fung JW, Yu CM, Yip G, Zhang Y, Chan H, Kum CC, Sanderson JE (2004) Variable left ventricular activation pattern in patients with heart failure and left bundle branch block. Heart 90(1):17–19CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Strickberger SA, Conti J, Daoud EG, Havranek E, Mehra MR, Pina IL, Young J (2005) Patient selection for cardiac resynchronization therapy: from the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation 111(16):2146–2150CrossRefPubMed Strickberger SA, Conti J, Daoud EG, Havranek E, Mehra MR, Pina IL, Young J (2005) Patient selection for cardiac resynchronization therapy: from the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation 111(16):2146–2150CrossRefPubMed
13.
Zurück zum Zitat Ploux S, Lumens J, Whinnett Z, Montaudon M, Strom M, Ramanathan C, Derval N, Zemmoura A, Denis A, De Guillebon M, Shah A, Hocini M, Jais P, Ritter P, Haissaguerre M, Wilkoff BL, Bordachar P (2013) Noninvasive electrocardiographic mapping to improve patient selection for cardiac resynchronization therapy: beyond QRS duration and left bundle branch block morphology. J Am Coll Cardiol 61(24):2435–2443CrossRefPubMed Ploux S, Lumens J, Whinnett Z, Montaudon M, Strom M, Ramanathan C, Derval N, Zemmoura A, Denis A, De Guillebon M, Shah A, Hocini M, Jais P, Ritter P, Haissaguerre M, Wilkoff BL, Bordachar P (2013) Noninvasive electrocardiographic mapping to improve patient selection for cardiac resynchronization therapy: beyond QRS duration and left bundle branch block morphology. J Am Coll Cardiol 61(24):2435–2443CrossRefPubMed
14.
Zurück zum Zitat Strik M, Regoli F, Auricchio A, Prinzen F (2012) Electrical and mechanical ventricular activation during left bundle branch block and resynchronization. J Cardiovasc Transl Res 5(2):117–126CrossRefPubMedPubMedCentral Strik M, Regoli F, Auricchio A, Prinzen F (2012) Electrical and mechanical ventricular activation during left bundle branch block and resynchronization. J Cardiovasc Transl Res 5(2):117–126CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Gold MR, Thebault C, Linde C, Abraham WT, Gerritse B, Ghio S, St John Sutton M, Daubert JC (2012) Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. Circulation 126(7):822–829CrossRefPubMed Gold MR, Thebault C, Linde C, Abraham WT, Gerritse B, Ghio S, St John Sutton M, Daubert JC (2012) Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. Circulation 126(7):822–829CrossRefPubMed
16.
Zurück zum Zitat Vassallo JA, Cassidy DM, Marchlinski FE, Buxton AE, Waxman HL, Doherty JU, Josephson ME (1984) Endocardial activation of left bundle branch block. Circulation 69(5):914–923CrossRefPubMed Vassallo JA, Cassidy DM, Marchlinski FE, Buxton AE, Waxman HL, Doherty JU, Josephson ME (1984) Endocardial activation of left bundle branch block. Circulation 69(5):914–923CrossRefPubMed
17.
Zurück zum Zitat Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R, Gonzalez-Juanatey JR, Alonso-Pulpon L, Delgado J, Brugada J, Pascual-Figal D (2013) Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 15(8):877–884CrossRefPubMedPubMedCentral Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R, Gonzalez-Juanatey JR, Alonso-Pulpon L, Delgado J, Brugada J, Pascual-Figal D (2013) Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 15(8):877–884CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Carasso S, Rakowski H, Witte KK, Smith P, Carasso D, Garceau P, Sasson Z, Parker JD (2009) Left ventricular strain patterns in dilated cardiomyopathy predict response to cardiac resynchronization therapy: timing is not everything. J Am Soc Echocardiogr 22(3):242–250CrossRefPubMed Carasso S, Rakowski H, Witte KK, Smith P, Carasso D, Garceau P, Sasson Z, Parker JD (2009) Left ventricular strain patterns in dilated cardiomyopathy predict response to cardiac resynchronization therapy: timing is not everything. J Am Soc Echocardiogr 22(3):242–250CrossRefPubMed
19.
Zurück zum Zitat Carita P, Verdecchia M, Ferro G, Buccheri D, Corrado E, Novo S, Pontone G (2016) Multimodality imaging in cardiac echinococcosis for diagnosis and follow-up of an untreatable cyst. Int J Cardiol 221:468–470CrossRefPubMed Carita P, Verdecchia M, Ferro G, Buccheri D, Corrado E, Novo S, Pontone G (2016) Multimodality imaging in cardiac echinococcosis for diagnosis and follow-up of an untreatable cyst. Int J Cardiol 221:468–470CrossRefPubMed
Metadaten
Titel
Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy
verfasst von
Chun-Li Wang
Chia-Tung Wu
Yung-Hsin Yeh
Lung-Sheng Wu
Yi-Hsin Chan
Chi-Tai Kuo
Pao-Hsien Chu
Lung-An Hsu
Wan-Jing Ho
Publikationsdatum
01.02.2017
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 6/2017
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-017-1083-5

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