http://repub.eur.nl/res/aut/17038/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/23654/ 2011-01-04T00:00:00Z Background-: The relative merits of left ventricular (LV) dyssynchrony, LV lead position, and myocardial scar to predict long-term outcome after cardiac resynchronization therapy remain unknown and were evaluated in the present study. Methods and results-: In 397 ischemic heart failure patients, 2-dimensional speckle tracking imaging was performed, with comprehensive assessment of LV radial dyssynchrony, identification of the segment with latest mechanical activation, and detection of myocardial scar in the segment where the LV lead was positioned. For LV dyssynchrony, a cutoff value of 130 milliseconds was used. Segments with <16.5% radial strain in the region of the LV pacing lead were considered to have extensive myocardial scar (>50% transmurality, validated in a subgroup with contrast-enhanced magnetic resonance imaging). The LV lead position was derived from chest X-ray. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Mean baseline LV radial dyssynchrony was 133±98 milliseconds. In 271 patients (68%), the LV lead was placed at the latest activated segment (concordant LV lead position), and the mean value of peak radial strain at the targeted segment was 18.9±12.6%. Larger LV radial dyssynchrony at baseline was an independent predictor of superior long-term survival (hazard ratio, 0.995; P≤0.001), whereas a discordant LV lead position (hazard ratio, 2.086; P≤0.001) and myocardial scar in the segment targeted by the LV lead (hazard ratio, 2.913; P<0.001) were independent predictors of worse outcome. Addition of these 3 parameters yielded incremental prognostic value over the combination of clinical parameters. Conclusions-: Baseline LV radial dyssynchrony, discordant LV lead position, and myocardial scar in the region of the LV pacing lead were independent determinants of long-term prognosis in ischemic heart failure patients treated with cardiac resynchronization therapy. Larger baseline LV dyssynchrony predicted superior long-term survival, whereas discordant LV lead position and myocardial scar predicted worse outcome. Copyright © 2011 American Heart Association. http://repub.eur.nl/res/pub/17948/ 2009-10-01T00:00:00Z Aim To assess the relative value of a novel measure of left ventricular (LV) dyssynchrony derived from magnetic resonance imaging (MRI) and the extent of scar tissue for prediction of response to cardiac resynchronization therapy (CRT).Methods and resultsThirty-five heart failure patients scheduled for CRT were included. Left ventricular dyssynchrony was defined as the standard deviation of 16 segment time-to-maximum radial wall thickness (SDt-16) obtained from a cine-set of short-axis slices. Delayed-enhanced MRI was performed for scar analysis. Echocardiography was used to determine response to CRT (reduction ≥15% in LV end-systolic volume 6 months after implantation). At follow-up, 21 patients (60%) were classified as responders. On MRI, SDt-16 was significantly higher in responders compared with non-responders (median 97 vs. 60 ms, P < 0.001), whereas the total extent of scar was larger in non-responders (median 35% vs. 3% in responders, P < 0.001). At the logistic regression analysis, SDt-16 was directly associated (OR = 6.3, 95% CI 3.1-9.9, P < 0.001) and the total extent of scar was inversely associated (OR = 0.52, 95% CI 0.43-0.87, P < 0.001) with response to CRT.ConclusionMagnetic resonance imaging offers the unique opportunity to assess LV dyssynchrony and scar extent in a single session. Both these parameters are important predictors of echocardiographic response to CRT. http://repub.eur.nl/res/pub/25433/ 2009-05-01T00:00:00Z The significance of left ventricular (LV) dyssynchrony for the prediction of response to cardiac resynchronization therapy (CRT) has been demonstrated. Parameters reflecting LV dyssynchrony (phase SD, histogram bandwidth) can be derived from gated myocardial perfusion SPECT (GMPS) using phase analysis. The feasibility of LV dyssynchrony assessment with phase analysis on GMPS using Quantitative Gated SPECT (QGS) software has not been demonstrated in patients undergoing CRT. The aim of the present study was to validate the QGS algorithm for phase analysis on GMPS in a direct comparison with echocardiography using tissue Doppler imaging (TDI) for LV dyssynchrony assessment. Also, prediction of response to CRT using GMPS and phase analysis was evaluated. Methods: Patients (n = 40) with severe heart failure (New York Heart Association class III-IV), an LV ejection fraction of no more than 35%, and a QRS complex greater than or equal to 120 ms were evaluated for LV dyssynchrony using GMPS and echocardiography with TDI. At baseline and after 6 mo of CRT, clinical status, LV volumes, and LV ejection fraction were evaluated. Patients with functional improvement were classified as CRT responders. Results: Both histogram bandwidth (r = 0.69, r2= 0.48, SEE = 25.4, P < 0.01) and phase SD (r = 0.65, r2= 0.42, SEE = 26.8, P < 0.01) derived from GMPS correlated significantly with TDI for assessment of LV dyssynchrony. At baseline, CRT responders showed a significantly larger histogram bandwidth (94° ± 23° vs. 68° ± 21°, P < 0.01) and a larger phase SD (26° ± 6° vs. 18° ± 5°, P < 0.01) than did nonresponders. Receiver-operating-characteristic curve analysis identified an optimal cutoff value of 72.5° for histogram bandwidth to predict CRT response, yielding a sensitivity of 83% and a specificity of 81%. For phase SD, sensitivity and specificity similar to those for histogram bandwidth were obtained at a cutoff value of 19.6°. Conclusion: QGS phase analysis on GMPS correlated significantly with TDI for the assessment of LV dyssynchrony. Moreover, a high accuracy for prediction of response to CRT was obtained using either histogram bandwidth or phase SD. Copyright http://repub.eur.nl/res/pub/24399/ 2009-02-10T00:00:00Z Objectives: The aim of the current study was to evaluate the relation between the extent of left ventricular (LV) reverse remodeling and clinical/echocardiographic improvement after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome. Background: Despite the current selection criteria, individual response to CRT varies significantly. Furthermore, it has been suggested that reduction in left ventricular end-systolic volume (LVESV) after CRT is related to outcome. Methods: A total of 302 CRT candidates were included. Clinical status and echocardiographic evaluation were performed before implantation and after 6 months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results: Based on different extents of LV reverse remodeling, 22% of patients were classified as super-responders (decrease in LVESV ≥30%), 35% as responders (decrease in LVESV 15% to 29%), 21% as nonresponders (decrease in LVESV 0% to 14%), and 22% negative responders (increase in LVESV). More extensive LV reverse remodeling resulted in more clinical improvement, with a larger increase in LV function and more reduction in mitral regurgitation. In addition, more LV reverse remodeling resulted in less heart failure hospitalizations and lower mortality during long-term follow-up (22 ± 11 months); 1- and 2-year hospitalization-free survival rates were 90% and 70% in the negative responder group compared with 98% and 96% in the super-responder group (log-rank p value <0.001). Conclusions: The extent of LV reverse remodeling at midterm follow-up is predictive for long-term outcome in CRT patients. http://repub.eur.nl/res/pub/29025/ 2008-11-15T00:00:00Z Velocity-encoded magnetic resonance imaging (VE-MRI), commonly used to perform flow measurements, can be applied for myocardial velocity analysis, similar to tissue Doppler imaging (TDI). In this study, a comparison between VE-MRI and TDI was performed for the assessment of left ventricular dyssynchrony and left ventricular filling pressures. Ten healthy volunteers and 22 patients with heart failure secondary to ischemic cardiomyopathy underwent both VE-MRI and TDI. Longitudinal myocardial peak systolic and diastolic velocities and time to peak systolic velocity (Ts) were measured with both techniques at the level of left ventricular septum and lateral wall. To quantify left ventricular dyssynchrony, the delay in Ts between basal septum and lateral wall was calculated (SLD) and patients were categorized into 3 groups: minimal (SLD <30 ms), intermediate (SLD = 30 to 60 ms) and extensive (SLD >60 ms) left ventricular dyssynchrony. The ratio of transmitral E wave velocity and mitral annulus septal early velocity (E/E' ratio) was also assessed, and patients were divided into 3 groups: normal (E/E' <8), probably abnormal (E/E' = 8 to 15), and elevated (E/E' >15) left ventricular filling pressures. Excellent correlations were observed for peak systolic velocity and peak diastolic velocity (r = 0.95, p <0.001) measured with TDI and VE-MRI. A small bias (p <0.001) of -1.1 ± 1.1 cm/s for peak systolic velocity and of -0.45 ± 1.03 cm/s for peak diastolic velocity was noted between the 2 techniques. A strong correlation was also noted between Ts measured with TDI and VE-MRI (r = 0.97, p <0.001) without a significant difference. TDI and VE-MRI showed an excellent agreement for left ventricular dyssynchrony and left ventricular filling pressures classification with a weighted κ of 0.96 and 0.91, respectively. In conclusion, TDI and VE-MRI are highly concordant and can be used interchangeably for the assessment of left ventricular dyssynchrony and filling pressures. http://repub.eur.nl/res/pub/14657/ 2008-10-21T00:00:00Z Objectives: The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position. Background: A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods: The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results: Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 ± 83 ml to 134 ± 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 ± 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004). Conclusions: Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. http://repub.eur.nl/res/pub/29185/ 2008-03-01T00:00:00Z http://repub.eur.nl/res/pub/29314/ 2008-03-01T00:00:00Z Aims: The aim of the current study was to evaluate the relationship between the presence of left ventricular (LV) dyssynchrony at baseline and acute vs. late improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). Methods and results: Sixty eight patients consecutive (LV ejection fraction 23 ± 8%) with at least moderate MR (≥grade 2+) were included. Echocardiography was performed at baseline, 1 day after CRT initiation and at 6 months follow-up. Speckle tracking radial strain was used to assess LV dyssynchrony at baseline. The majority of patients improved in MR after CRT, with 43% improving immediately after CRT, and 20% improving late (after 6 months) after CRT. Early and late responders had similar extent of LV dyssynchrony (209 ± 115 ms vs. 190 ± 118 ms, P = NS); however, the site of latest activation in early responders was mostly inferior or posterior (adjacent to the posterior papillary muscle), whereas the lateral wall was the latest activated segment in late responders. Conclusion: Current data suggest that the presence of baseline LV dyssynchrony is related to improvement in MR after CRT. LV dyssynchrony involving the posterior papillary muscle may lead to an immediate reduction in MR, whereas LV dyssynchrony in the lateral wall resulted in late response to CRT. http://repub.eur.nl/res/pub/36211/ 2007-04-24T00:00:00Z Objectives: The purpose of this study was to compare left ventricular (LV) dyssynchrony assessment by gated myocardial perfusion single-photon emission computed tomography (SPECT) (GMPS) and tissue Doppler imaging (TDI). Background: Recently, it has been suggested that LV dyssynchrony is an important predictor of response to cardiac resynchronization therapy (CRT); dyssynchrony is predominantly assessed by TDI with echocardiography. Information on LV dyssynchrony can also be provided by GMPS with phase analysis of regional LV maximal count changes throughout the cardiac cycle, which tracks the onset of LV thickening. Methods: In 75 patients with heart failure, depressed LV function, and wide QRS complex, GMPS and 2-dimensional echocardiography, including TDI, were performed as part of clinical screening for eligibility for CRT. Clinical status was evaluated with New York Heart Association functional classification, 6-min walk distance, and quality-of-life score. Different parameters (histogram bandwidth, phase SD, histogram skewness, and histogram kurtosis) of LV dyssynchrony were assessed from GMPS and compared with LV dyssynchrony on TDI with Pearson's correlation analyses. Results: Histogram bandwidth and phase SD correlated well with LV dyssynchrony assessed with TDI (r = 0.89, p < 0.0001 and r = 0.80, p < 0.0001, respectively). Histogram skewness and kurtosis correlated less well with LV dyssynchrony on TDI (r = -0.52, p < 0.0001 and r = -0.45, p < 0.0001, respectively). Conclusions: The LV dyssynchrony assessed from GMPS correlated well with dyssynchrony assessed by TDI; histogram bandwidth and phase SD showed the best correlation with LV dyssynchrony on TDI. These parameters seem most optimal for assessment of LV dyssynchrony with gated SPECT. Outcome studies after CRT are needed to further validate the use of GMPS for assessment of LV dyssynchrony. http://repub.eur.nl/res/pub/35872/ 2007-01-01T00:00:00Z Aims: At present, 20-30% of patients do not respond to cardiac resynchronization therapy (CRT). In this study, the relation between the extent of viable myocardium and scar tissue vs. response to CRT was evaluated. In addition, the presence of scar tissue in the left ventricular (LV) lead position was specifically related to response to CRT. Methods and results: A total of 51 consecutive patients with ischaemic heart failure and substantial LV dyssynchrony undergoing CRT were included. All patients underwent gated SPECT before CRT implantation to determine the extent of scar tissue and viable myocardium. Clinical and echocardiographic parameters were assessed at baseline and after 6 months of CRT. The results demonstrated direct relations between the response to CRT and the extent of viable myocardium and scar tissue. In addition, the 15 patients (29%) with transmural scar tissue (< 50% tracer activity) in the region of the LV pacing lead showed no improvement after 6 months of CRT. Conclusion: The extent of scar tissue and viable myocardium were directly related to the response to CRT. Furthermore, scar tissue in the LV pacing lead region may prohibit response to CRT. Evaluation for viability and scar tissue may be considered in the selection process for CRT.