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  • 1
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    Mechanical dyssynchrony combined with septal scarring reliably identifies responders to cardiac resynchronization therapy
    Oxford University Press (OUP) ; 2023
    In:  European Heart Journal - Cardiovascular Imaging Vol. 24, No. Supplement_1 ( 2023-06-19)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 24, No. Supplement_1 ( 2023-06-19)
    Kurzfassung: Type of funding sources: Foundation. Main funding source(s): Research Foundation Flanders (FWO). Background The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodeling after cardiac resynchronization therapy (CRT). In contrast, recent studies suggest that presence of myocardial scarring – particularly in the septal wall – reduces the effect of CRT. Recently, a combined assessment of mechanical dyssynchrony and septal wall scarring has demonstrated high predictive power for CRT response. However, a direct comparison of different markers of mechanical dyssynchrony has not yet been performed. Aim This study: (I) investigated how well a combined assessment of different markers of mechanical dyssynchrony and septal scarring identifies responders to CRT, and (II) evaluated potential differences in predictive power. Methods In a prospective multicentre study in 170 CRT recipients, septal flash (SF) or apical rocking (ApRock), systolic stretch index (SSI) and lateral-to-septal (LW-S) work difference were assessed on echocardiography. SSI was calculated from longitudinal strain traces of the four-chamber view as the sum of the septal systolic stretch and lateral systolic pre-stretch before aortic valve closure. The LW-S work difference was calculated from the regional work of the lateral wall and septal wall - considering the averaged work from the basal- and mid-ventricular segments in the apical four-chamber view. Myocardial scarring of the septum was quantified on cardiac magnetic resonance imaging (CMR) late gadolinium enhancement (LGE) images (n=125 patients), or excluded based on a coronary angiogram and clinical history (n=45 patients). Myocardial scarring was reported regionally as percentage of total amount of scarred tissue per wall. The study’s endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume 12 months after CRT implantation. AUC’s from ROC curves were used to investigate the predictive power of the different markers for CRT response. Results The AUC’s for the combined assessment of the markers of mechanical dyssynchrony and septal scarring as predictor of CRT-response were 0.86 (95% CI: 0.79–0.91) for presence of SF or ApRock, 0.81 (95% CI: 0.74–0.88) for SSI, and 0.84 (95% CI: 0.76–0.90) for LW-S work difference (all p & lt;0.0001). No significant difference was observed between the different markers of mechanical dyssynchrony (p & gt;0.05 between all). Conclusions The combined assessment of mechanical dyssynchrony and septal scarring identified CRT responders with high predictive power. Both visual and quantitative markers demonstrated similar results. Our data demonstrates the importance of assessing LV mechanics and scarring in CRT-candidates, which can easily be achieved in clinical routine.
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jead119.213
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2023
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 2
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    P975 Echocardiography and nuclear medicine imaging techniques are insufficient for scar detection in patients referred for cardiac resynchronization therapy
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Cardiovascular Imaging Vol. 21, No. Supplement_1 ( 2020-01-01)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
    Kurzfassung: The study was supported by Center for Cardiological Innovation Background Many patients referred for cardiac resynchronization therapy (CRT) do not respond to the treatment. Scar either in septum or the left ventricular (LV) lateral wall, as well as global scar burden, influence the outcome negatively. Preoperative scar assessment is therefore recommended in this patient group. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is considered reference standard for scar detection, but is not always available. Purpose To investigate the ability of advanced echocardiographic and nuclear imaging techniques to detect septal and left ventricular (LV) lateral wall scar in patients referred for CRT, compared to late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR). Methods Scar was quantified as percentage segmental LGE in 131 patients (age 66 ± 10, 66% male, QRS-width 164 ± 17ms) referred for CRT, 92% with left bundle branch block (LBBB). Longitudinal strain was assessed by speckle tracking echocardiography in 130 patients (641 septal and 630 LV lateral wall segments). Wall motion score index (WMSI) was assessed visually in all patients by an experienced operator, and graded from one to four. Glucose metabolism was assessed by 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) in 52 patients. Perfusion was assessed in 46 patients by either 13N-ammonia PET (n = 32) or Single Photon Emission Computed Tomography (SPECT) (n = 14). Metabolism and perfusion were reported as percentages of the segment with maximum tracer uptake. The ability of each parameter to identify scar was evaluated with receiver operating characteristic (ROC) curves with calculation of area under the curve (AUC) and 95% confidence interval (CI). AUC≥0.800 was considered reasonable agreement with LGE. Results Scar was present in 574 of total 2090 interpretable segments (79% ischemic etiology). Globally, perfusion (AUC = 0.845, 95% CI 0.777-0.914) and glucose metabolism (AUC = 0.807, 95% CI 0.758-0.855) adequately detected transmural scars, but not smaller scars (all AUC  & lt; 0.800). Echocardiographic parameters failed to detect global scars irrespective of size (all AUC  & lt; 0.800). However, the associations between echocardiographic/nuclear parameters and scars were highly dependent on myocardial region. In the LV lateral wall, glucose metabolism precisely detected transmural scars (AUC = 0.958, 95% CI 0.902-1.00) and WMSI proved reasonable agreement (AUC = 0.812, 95% CI 0.737-0.887), while the rest of the parameters did not (all AUC  & lt; 0.800). Smaller scars in this region was not detected by any parameter tested (all AUC  & lt; 0.800). No parameter adequately detected septal scars, not even those with transmural involvement (all AUC  & lt; 0.800) (Figure). Conclusions Neither echocardiographic nor nuclear imaging techniques can replace LGE-CMR in scar assessment prior to CRT. Septum is especially challenging, explained by LBBB-induced reduction in strain, metabolism and perfusion in this region. Abstract P975 Figure. Detection of transmural septal scar
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jez319.605
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 3
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    P1585 Cardiac magnetic resonance estimated extracellular volume fraction, but not native T1 mapping, detects scar in patients referred for cardiac resynchronization therapy
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Cardiovascular Imaging Vol. 21, No. Supplement_1 ( 2020-01-01)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
    Kurzfassung: The study was supported by Center for Cardiological Innovation Background Myocardial scar burden (focal fibrosis) is associated with poor response to cardiac resynchronization therapy (CRT), and should preferably be detected prior to device implantation. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is considered reference standard for scar detection, but is not available in renal failure. Diffuse fibrosis is assessed by T1 mapping CMR with or without calculation of extracellular volume fraction (ECV). The method is vulnerable to partial volume effects, thus subendocardial tissue is most often not included in mapping analyses. Whether the contrast-free native T1mapping could replace LGE in the preoperative evaluation of patients referred for CRT is unknown. Purpose To investigate if native T1 mapping and calculation of ECV can adequately detect scar in patients referred for CRT. Methods Scar was quantified as percentage segmental LGE in 45 patients (age 65 ± 10 years, 71% male, QRS-width 165 ± 17ms) referred for CRT. In total 720 segments were analyzed, and LGE≥50% was considered transmural scar. T1-mapping before and after contrast agent injection was performed in all patients. ECV was calculated based on the ratio between tissue T1 relaxation change and blood T1 relaxation change after contrast agent injection, corrected for the haematocrit level. The agreement between native T1/ECV and scar was evaluated with receiver operating characteristic (ROC) curves with calculation of area under the curve (AUC) and 95% confidence interval (CI). Results LGE was present in 255 segments, 465 segments were without LGE. Average native T1 in segments with LGE was 1028 ± 88 ms, and 1040 ± 60 ms in segments without LGE (p = 0.16). The corresponding numbers for ECV were 38.7 ± 10.9% and 30.0 ± 4.7%, p  & lt; 0.001. Native T1 showed poor agreement to scar independent of scar size (AUC = 0.532, 95% CI 0.485-0.578 for scars of all sizes, and AUC = 0.572, 95% CI 0.495-0.650 for transmural scars). ECV, on the other hand, showed reasonable agreement with scar of all sizes (AUC = 0.777, 95% CI 0.739-0.815), and good agreement with transmural scars (AUC = 0.856, 95% CI 0.811-0.902). (Figure) Conclusion The contrast-free CMR technique T1 mapping does not adequately detect scars in patients referred for CRT. Adding post contrast T1 measurements and calculating ECV improves accuracy, especially for transmural scars. Future studies should investigate if diffuse fibrosis could be predictive of CRT response. Abstract P1585 Figure. Detection of transmural scars
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jez319.1005
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 4
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    160 Echocardiographic assessment of CRT candidates. Does additional scar evaluation by MRI improve prediction of response?
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Cardiovascular Imaging Vol. 21, No. Supplement_1 ( 2020-01-01)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
    Kurzfassung: Myocardial scar presence and extent, has a considerable influence on response to cardiac resynchronization therapy (CRT). Apical rocking (ApRock) and septal flash (SF) are associated with favourable outcome after CRT. Little is known however to which extent visual assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. We therefore investigated, if additional scar assessment by cardiac magnetic resonance imaging (MRI) adds to the predictive value of the visual evaluation of echocardiographic images in CRT candidates. Methods A total of 201 unselected patients referred for CRT, who fulfil the contemporary guidelines for CRT implantation, were enrolled in this prospective multicentre study. Two experienced observers visually assessed echocardiographic images before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments of the left ventricle (LV), resulting in a CRT response prediction (i.e. Integrative Prediction). A third observer provided a consensus reading in case of disagreement. All observers were blinded to all patient information other than the ischaemic aetiology of heart failure. Independent from that, segmental myocardial scar burden was objectified by late gadolinium enhancement (LGE) cardiac MRI (LGE  & gt; 50%). CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, one year after device implantation. Results Overall, 69 (34%) patients had an ischaemic aetiology of heart failure. Before CRT, ApRock and SF were present in 129 (64%) and 136 (68%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.85 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.77-0.91) (Figure A), while the echocardiographic Integrative Prediction had an AUC of 0.90 (95% CI: 0.84-0.95), with a sensitivity of 93% and a specificity of 87% for the prediction of CRT response (Figure B) (p  & lt; 0.05 vs. ApRock and SF alone). When combining information on ApRock, SF and the number of scarred segments on MRI in a statistical model, the AUC was comparable to the echocardiographic Integrative Prediction [0.90 (95% CI: 0.84-0.96)] as was sensitivity and specificity (91% and 83%, respectively, p = N.S. vs. Integrative Prediction) (Figure C). Conclusions An integrative visual assessment of LV function has an excellent predictive value for CRT response. Our data show, that the echocardiographic estimation of scar burden is sufficiently accurate and cannot be further improved by an additional MRI scar assessment. Abstract 160 Figure.
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jez319.038
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 5
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    553 Acute re-distribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Cardiovascular Imaging Vol. 21, No. Supplement_1 ( 2020-01-01)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
    Kurzfassung: In patients with dilated cardiomyopathy and left bundle branch block (LBBB), different regions of the left ventricle (LV) have been shown to perform different amounts of work. In this study, we investigate the acute impact of cardiac resynchronization therapy (CRT) on regional LV work distribution and its relation to long-term reverse-remodelling. Methods We recruited 140 heart failure patients, referred for CRT. Regional myocardial work was calculated from non-invasive echocardiographic segmental stress-strain-loop-area before and immediately after CRT. The magnitude of volumetric reverse-remodelling was determined from the change in LV end-systolic volume (ESV), 11 ± 3 months after implantation. Characteristics of patients with the lowest and highest quartile of LV ESV reverse remodelling (LV ESV reduction of less than 10% and LV ESV reduction of more than -48%) were compared. Results Before CRT, myocardial work showed significant differences among the walls of the LV (Figure A). CRT caused an acute re-distribution of myocardial work, on average with most increase in the septum and most decrease laterally (all walls p  & lt; 0.05) and lead to a homogeneous work distribution (Figure B). The acute change in the difference between lateral and septal wall work (Δ Lateral-to-septal work) correlated significantly with LV ESV reverse-remodelling (r = 0.63, p  & lt; 0.0001). The smallest changes in work were seen in the patients with the least LV ESV reverse remodelling (Figure C, red markers), while patients with the most LV ESV reverse remodelling showed the largest changes in work (Figure C, green markers). In multivariate linear regression analysis, including conventional parameters such as pre-implant QRS duration, LV ejection fraction, LV end-diastolic volume and global longitudinal strain, the re-distribution of work across the septal and lateral walls appeared as the strongest determinant of volumetric reverse-remodelling after CRT (R²=0.393, p  & lt; 0.0001). Conclusions The acute re-distribution of regional myocardial work between the septal and lateral wall of the left ventricle is an important determinant of long term reverse-remodelling after CRT-implantation. Our data suggest that modification of regional loading is the mode of action of CRT treatment. Abstract 553 Figure.
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jez319.283
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 6
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    The PerPAIN trial: a pilot randomized controlled trial of personalized treatment allocation for chronic musculoskeletal pain—a protocol
    Springer Science and Business Media LLC ; 2022
    In:  Pilot and Feasibility Studies Vol. 8, No. 1 ( 2022-12-09)
    Details
    In: Pilot and Feasibility Studies, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2022-12-09)
    Kurzfassung: The therapy of chronic musculoskeletal pain (CMSP) is complex and the treatment results are often insufficient despite numerous therapeutic options. While individual patients respond very well to specific interventions, other patients show no improvement. Personalized treatment assignment offers a promising approach to improve response rates; however, there are no validated cross-disease allocation algorithms available for the treatment of chronic pain in validated personalized pain interventions. This trial aims to test the feasibility and safety of a personalized pain psychotherapy allocation with three different treatment modules and estimate initial signals of efficacy and utility of such an approach compared to non-personalized allocation. Methods This is a randomized, controlled assessor-blinded pilot trial with a multifactorial parallel arm design. CMSP patients ( n = 105) will be randomly assigned 1:1 to personalized or non-personalized treatment based on a cluster assignment of the West Haven-Yale Multidimensional Pain Inventory (MPI). In the personalized assignment condition, patients with high levels of distress receive an emotional distress-tailored intervention, patients with pain-related interference receive an exposure/extinction-tailored treatment intervention and patients who adapt relatively well to the pain receive a low-level smartphone-based activity diary intervention. In the control arm, patients receive one of the two non-matching interventions. Effect sizes will be calculated for change in core pain outcome domains (pain intensity, physical and emotional functioning, stress experience, participant ratings of improvement and satisfaction) after intervention and at follow-up. Feasibility and safety outcomes will assess rates of recruitment, retention, adherence and adverse events. Additional data on neurobiological and psychological characteristics of the patients are collected to improve treatment allocation in future studies. Conclusion Although the call for personalized treatment approaches is widely discussed, randomized controlled trials are lacking. As the personalization of treatment approaches is challenging, both allocation and intervention need to be dynamically coordinated. This study will test the feasibility and safety of a novel study design in order to provide a methodological framework for future multicentre RCTs for personalized pain psychotherapy. Trial registration German Clinical Trials Register, DRKS00022792 ( https://www.drks.de ). Prospectively registered on 04/06/2021.
    Materialart: Online-Ressource
    ISSN: 2055-5784
    URL: Article
    DOI: 10.1186/s40814-022-01199-6
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2022
    ZDB Id: 2809935-7
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  • 7
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    United States Epilepsy Center Characteristics : A Data Analysis From the National Association of Epilepsy Centers
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Neurology Vol. 98, No. 5 ( 2022-02-1), p. e449-e458
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 98, No. 5 ( 2022-02-1), p. e449-e458
    Kurzfassung: Patients with drug-resistant epilepsy (DRE) may benefit from specialized testing and treatments to better control seizures and improve quality of life. Most evaluations and procedures for DRE in the United States are performed at epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). On an annual basis, the NAEC collects data from accredited epilepsy centers on hospital-based epilepsy monitoring unit (EMU) size and admissions, diagnostic testing, surgeries, and other services. This article highlights trends in epilepsy center services from 2012 through 2019. Methods We analyzed data reported in 2012, 2016, and 2019 from all level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level and center population category. EMU beds, EMU admissions, epileptologists, and aggregate procedure volumes were also described using rates per population per year. Results During the period studied, the number of NAEC accredited centers increased from 161 to 256, with the largest increases in adult- and pediatric-only centers. Growth in EMU admissions (41%), EMU beds (26%), and epileptologists (109%) per population occurred. Access to specialized testing and services broadly expanded. The largest growth in procedure volumes occurred in laser interstitial thermal therapy (LiTT) (61%), responsive neurostimulation (RNS) implantations (114%), and intracranial monitoring without resection (152%) over the study period. Corpus callosotomies and vagus nerve stimulator (VNS) implantations decreased (−12.8% and −2.4%, respectively), while growth in temporal lobectomies (5.9%), extratemporal resections (11.9%), and hemispherectomies/otomies (13.1%) lagged center growth (59%), leading to a decrease in median volumes of these procedures per center. Discussion During the study period, the availability of specialty epilepsy care in the United States improved as the NAEC implemented its accreditation program. Surgical case complexity increased while aggregate surgical volume remained stable or declined across most procedure types, with a corresponding decline in cases per center. This article describes recent data trends and current state of resources and practice across NAEC member centers and identifies several future directions for driving systematic improvements in epilepsy care.
    Materialart: Online-Ressource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000013130
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
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  • 8
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    Following the TraCS of exoplanets with Pan-Planets: Wendelstein-1b and Wendelstein-2b
    EDP Sciences ; 2020
    In:  Astronomy & Astrophysics Vol. 639 ( 2020-7), p. A130-
    Details
    In: Astronomy & Astrophysics, EDP Sciences, Vol. 639 ( 2020-7), p. A130-
    Kurzfassung: Hot Jupiters seem to get rarer with decreasing stellar mass. The goal of the Pan-Planets transit survey was the detection of such planets and a statistical characterization of their frequency. Here, we announce the discovery and validation of two planets found in that survey, Wendelstein-1b and Wendelstein-2b, which are two short-period hot Jupiters that orbit late K host stars. We validated them both by the traditional method of radial velocity measurements with the HIgh Resolution Echelle Spectrometer and the Habitable-zone Planet Finder instruments and then by their Transit Color Signature (TraCS). We observed the targets in the wavelength range of 4000−24 000 Å and performed a simultaneous multiband transit fit and additionally determined their thermal emission via secondary eclipse observations. Wendelstein-1b is a hot Jupiter with a radius of 1.0314 −0.0061 +0.0061 R J and mass of 0.592 −0.129 +0.0165 M J , orbiting a K7V dwarf star at a period of 2.66 d, and has an estimated surface temperature of about 1727 −90 +78 K. Wendelstein-2b is a hot Jupiter with a radius of 1.1592 −0.0210 +0.0204 R J and a mass of 0.731 −0.311 +0.0541 M J , orbiting a K6V dwarf star at a period of 1.75 d, and has an estimated surface temperature of about 1852 −140 +120 K. With this, we demonstrate that multiband photometry is an effective way of validating transiting exoplanets, in particular for fainter targets since radial velocity follow-up becomes more and more costly for those targets.
    Materialart: Online-Ressource
    ISSN: 0004-6361 , 1432-0746
    URL: Article
    DOI: 10.1051/0004-6361/202037715
    RVK:
    UA 1000
    RVK:
    US 1090
    Sprache: Englisch
    Verlag: EDP Sciences
    Publikationsdatum: 2020
    ZDB Id: 1458466-9
    SSG: 16,12
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  • 9
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    Combined assessment of septal scar and septal flash by cardiac magnetic resonance identifies responders to cardiac resynchronization therapy
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal - Cardiovascular Imaging Vol. 23, No. Supplement_1 ( 2022-02-04)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 23, No. Supplement_1 ( 2022-02-04)
    Kurzfassung: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority. Research grants of the University of Leuven. Background Left ventricular (LV) scar, particularly in the lateral wall and septum, reduces response rate to cardiac resynchronization therapy (CRT), whereas a dyssynchronous LV contraction pattern (septal flash) suggests good response. Lateral wall scar abolishes septal flash. Therefore, a combined approach of septal scar and septal flash may characterize the myocardial substrate responsive to CRT. Cardiac magnetic resonance (CMR) may assess both scar and contraction pattern. Purpose The present study aimed to determine if combined assessment of septal scar and septal flash by CMR as single image modality identifies responders to CRT. Methods We investigated all CRT recipients with available CMR from a prospective, multicenter study (n = 136), with both ischemic and non-ischemic heart failure. Septal scar was assessed by late gadolinium enhancement (LGE) from a stack of short axis slices (n = 128) and septal flash determined visually on ordinary cine sequences (n = 136). CRT response was defined as ≥15% reduction in LV end-systolic volume by echocardiography at 6 months follow-up. We also assessed heart transplantation or death of any cause 39 ± 13 months after device implantation. Results In multivariate analysis including percentage septal scar (LGE), septal flash, QRS-duration and QRS-morphology, septal LGE and septal flash were the only independent predictors of CRT response (both p  & lt; 0.001). A combined approach of septal LGE and septal flash predicted CRT response with area under the curve 0.86 (95% confidence interval (CI): 0.78-0.94) and long-term survival without heart transplantation with hazard ratio 0.18 (95% CI: 0.05-0.61). A practical approach to selection of CRT candidates by septal LGE and septal flash is illustrated in the present figure. As shown, absence of septal LGE indicated excellent response rate (93%) to CRT independent of other parameters. When septal LGE was present, however, overall response rate was substantially lower (58%), but presence or absence of septal flash separated responders from non-responders with high accuracy. This sequential approach correctly classified 86% of patients. Importantly, the approach was equally accurate in patients with intermediate QRS duration (130-150ms), where 93% of patients were correctly classified. Conclusions Combined assessment of septal LGE and septal flash by CMR as single image modality identifies CRT responders with high accuracy and predicts long-term survival. Abstract Figure.
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jeab289.397
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2022
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
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  • 10
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    561 Targeting septal work and viability identifies responders to cardiac resynchronization therapy
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Cardiovascular Imaging Vol. 21, No. Supplement_1 ( 2020-01-01)
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
    Kurzfassung: The study was supported by Center for Cardiological Innovation. Introduction Septal dysfunction is the dominant mechanism of left ventricular (LV) failure in left bundle branch block (LBBB). We hypothesize that, provided septum is viable, septal function can recover and hence LV function improve after cardiac resynchronization therapy (CRT). Purpose To determine if combined assessment of septal function and viability identifies responders to CRT. Methods In a prospective multicenter study of 200 unselected patients referred for CRT, we measured myocardial strain by speckle-tracking echocardiography and regional work by pressure-strain analysis before and 7 ± 1 months after CRT. Viability was assessed by late gadolinium enhancement cardiac magnetic resonance imaging (n = 123). CRT response was defined as ≥15% reduction in LV end-systolic volume. Results Before CRT, septal work was 258 ± 463 and LV lateral wall work 1469 ± 674 mmHg·% (p  & lt; 0.0001). In CRT responders, septal work was restored to 1243 ± 495 mmHg·%, whereas non-responders showed less marked improvement (p  & lt; 0.0001). The figure illustrates a typical CRT responder with negative septal work and a large difference between work in the LV lateral wall and septum (panel A). There was no septal scar (panel B) and, after 6 months with CRT, septal work was recovered (panel C). Pressure-strain loops illustrate that CRT converted inefficient septal contractions with substantial negative (wasted) work to positive work throughout systole. For the entire study population, the difference between work in the LV lateral wall and septum predicted CRT response with area under the curve (AUC) 0.75 (95% CI: 0.68-0.83) and was feasible in 98% of patients. Furthermore, septal scar predicted non-response to CRT with AUC 0.76 (95% CI: 0.65-0.86). Combining work difference and septal viability improved AUC for CRT response to 0.85 (95% CI: 0.76-0.94) (figure panel D). The AUC was similar for QRS 120-150 and & gt;150 ms. Conclusions The proposed combined approach with assessment of septal work and viability identified CRT responders with high precision. Abstract 561 Figure.
    Materialart: Online-Ressource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jez319.291
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2020
    ZDB Id: 2042482-6
    ZDB Id: 2647943-6
    Standort Signatur Einschränkungen Verfügbarkeit
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