Regional contributions to left ventricular stroke volume determined by cardiac magnetic resonance imaging in cardiac resynchronization therapy
(2021) In BMC Cardiovascular Disorders 21(1).- Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SVlong%), lateral (SVlat%), and septal (SVsept%) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response.
METHODS: Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms)... (More)
BACKGROUND: Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SVlong%), lateral (SVlat%), and septal (SVsept%) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response.
METHODS: Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms) underwent CMR. SVlong% was calculated as the volume encompassed by the atrioventricular plane displacement (AVPD) from end diastole (ED) to end systole (ES) divided by total SV. SVlat%, and SVsept% were calculated as the volume encompassed by radial contraction from ED to ES. Twenty age- and sex-matched healthy volunteers were used as controls. The regional measures were compared to outcome response defined as ≥ 15% decrease in echocardiographic LV end-systolic volume (LVESV) from pre- to 6-months post CRT (delta, Δ).
RESULTS: AVPD and SVlong% were lower in patients compared to controls (8.3 ± 3.2 mm vs 15.3 ± 1.6 mm, P < 0.001; and 53 ± 18% vs 64 ± 8%, P < 0.01). SVsept% was lower (0 ± 15% vs 10 ± 4%, P < 0.01) with a higher SVlat% in the patient group (42 ± 16% vs 29 ± 7%, P < 0.01). There were no differences between responders and non-responders in neither SVlong% (P = 0.87), SVlat% (P = 0.09), nor SVsept% (P = 0.65). In patients with septal net motion towards the right ventricle (n = 28) ΔLVESV was - 18 ± 22% and with septal net motion towards the LV (n = 37) ΔLVESV was - 19 ± 23% (P = 0.96).
CONCLUSIONS: Longitudinal function, expressed as AVPD and longitudinal contribution to SV, is decreased in patients with HF scheduled for CRT. A larger lateral contribution to SV compensates for the abnormal septal systolic net movement. However, LV reverse remodeling could not be predicted by these regional contributors to SV.
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- author
- Östenson, Björn LU ; Ostenfeld, Ellen LU ; Werther-Evaldsson, Anna LU ; Roijer, Anders LU ; Bakos, Zoltan LU ; Kanski, Mikael LU ; Heiberg, Einar LU ; Arheden, Håkan LU ; Borgquist, Rasmus LU and Carlsson, Marcus LU
- organization
-
- Clinical Physiology (Lund)
- Lund Cardiac MR Group (research group)
- Cardiology
- Arrhytmias and Cardiac Device treatment (research group)
- WCMM-Wallenberg Centre for Molecular Medicine
- Section V
- Clinical studies af Atrial Fibrillation (research group)
- Electrocardiology Research Group - CIEL (research group)
- publishing date
- 2021-10-26
- type
- Contribution to journal
- publication status
- published
- subject
- in
- BMC Cardiovascular Disorders
- volume
- 21
- issue
- 1
- article number
- 519
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:34702172
- scopus:85118271261
- ISSN
- 1471-2261
- DOI
- 10.1186/s12872-021-02325-7
- language
- English
- LU publication?
- yes
- additional info
- © 2021. The Author(s).
- id
- 725e586e-8f72-4e17-b357-3a9e74d1f92f
- date added to LUP
- 2021-10-29 18:58:04
- date last changed
- 2024-03-23 12:47:07
@article{725e586e-8f72-4e17-b357-3a9e74d1f92f, abstract = {{<p>BACKGROUND: Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SVlong%), lateral (SVlat%), and septal (SVsept%) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response.</p><p>METHODS: Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms) underwent CMR. SVlong% was calculated as the volume encompassed by the atrioventricular plane displacement (AVPD) from end diastole (ED) to end systole (ES) divided by total SV. SVlat%, and SVsept% were calculated as the volume encompassed by radial contraction from ED to ES. Twenty age- and sex-matched healthy volunteers were used as controls. The regional measures were compared to outcome response defined as ≥ 15% decrease in echocardiographic LV end-systolic volume (LVESV) from pre- to 6-months post CRT (delta, Δ).</p><p>RESULTS: AVPD and SVlong% were lower in patients compared to controls (8.3 ± 3.2 mm vs 15.3 ± 1.6 mm, P < 0.001; and 53 ± 18% vs 64 ± 8%, P < 0.01). SVsept% was lower (0 ± 15% vs 10 ± 4%, P < 0.01) with a higher SVlat% in the patient group (42 ± 16% vs 29 ± 7%, P < 0.01). There were no differences between responders and non-responders in neither SVlong% (P = 0.87), SVlat% (P = 0.09), nor SVsept% (P = 0.65). In patients with septal net motion towards the right ventricle (n = 28) ΔLVESV was - 18 ± 22% and with septal net motion towards the LV (n = 37) ΔLVESV was - 19 ± 23% (P = 0.96).</p><p>CONCLUSIONS: Longitudinal function, expressed as AVPD and longitudinal contribution to SV, is decreased in patients with HF scheduled for CRT. A larger lateral contribution to SV compensates for the abnormal septal systolic net movement. However, LV reverse remodeling could not be predicted by these regional contributors to SV.</p>}}, author = {{Östenson, Björn and Ostenfeld, Ellen and Werther-Evaldsson, Anna and Roijer, Anders and Bakos, Zoltan and Kanski, Mikael and Heiberg, Einar and Arheden, Håkan and Borgquist, Rasmus and Carlsson, Marcus}}, issn = {{1471-2261}}, language = {{eng}}, month = {{10}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{BMC Cardiovascular Disorders}}, title = {{Regional contributions to left ventricular stroke volume determined by cardiac magnetic resonance imaging in cardiac resynchronization therapy}}, url = {{http://dx.doi.org/10.1186/s12872-021-02325-7}}, doi = {{10.1186/s12872-021-02325-7}}, volume = {{21}}, year = {{2021}}, }