Global myocardial work index predicts response to biventricular pacing in patients with non-left bundle branch block

被引:0
作者
Kondo, Shun [1 ]
Inden, Yasuya [1 ]
Yanagisawa, Satoshi [1 ]
Miyamae, Kiichi [1 ]
Miyazawa, Hiroyuki [1 ]
Goto, Takayuki [1 ]
Tachi, Masaya [1 ]
Iwawaki, Tomoya [1 ]
Yamauchi, Ryota [1 ]
Hiramatsu, Kei [1 ]
Shimojo, Masafumi [1 ]
Tsuji, Yukiomi [1 ]
Murohara, Toyoaki [1 ]
机构
[1] Nagoya Univ, Grad Sch Med, Dept Cardiol, 65 Tsurumaicho,Showa Ku, Nagoya 4668550, Japan
关键词
Cardiac resynchronization therapy; Heart failure; Non-left bundle branch block; Myocardial work; Pressure-strain loops analysis; CARDIAC-RESYNCHRONIZATION-THERAPY; INTRAVENTRICULAR-CONDUCTION DELAY; LEFT-VENTRICULAR DYSSYNCHRONY; HEART-FAILURE; QRS DURATION; MORPHOLOGY; ECHOCARDIOGRAPHY; STRAIN; RECOMMENDATIONS; QUANTIFICATION;
D O I
10.1002/ehf2.15246
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimsCardiac resynchronization therapy (CRT) improves the prognosis of patients with heart failure (HF) and wide QRS complex. However, patients with non-left bundle branch block (LBBB) show a poor response to CRT. This study evaluated myocardial work estimated by pressure-strain loops on echocardiography for predicting response to CRT in patients with non-LBBB.Methods and resultsOf 267 patients who underwent CRT implantation, 54 patients with non-LBBB (mean age, 62 +/- 12 years, 72% males, and 24% with ischemic cardiomyopathy) were retrospectively included. Two-dimensional speckle-tracking echocardiography was performed before and at 6-month follow-up in all patients. Myocardial work was estimated by pressure-strain loop analysis using speckle-tracking echocardiography and non-invasive blood pressure measurement. CRT response was defined as a >= 15% decrease in left ventricular end-systolic volume on echocardiography at the 6-month follow-up. The mean left ventricular ejection fraction (LVEF) before implantation was 27% +/- 8% in total. Six months after implantation, 18 patients (33%) responded to CRT. The absolute LVEF improvement for responders and non-responders were 5.5% +/- 6.9% and 1.3% +/- 7.5%, respectively (P = 0.021). Baseline global work index (GWI), which is the average myocardial work based on the pressure-strain loop, was significantly higher in the responder group than in the non-responder group (590 +/- 271 vs. 409 +/- 216 mmHg%; P = 0.010). Multivariable analysis showed GWI to be an independent predictor of CRT response (odds ratio, 1.109; 95% confidence interval [CI], 1.013-1.213; P = 0.024). Receiver operating characteristic curve analysis determined the cut-off value of GWI for response as 456 mmHg% (AUC 0.700, 95% CI 0.553-0.840; P = 0.019). During the median 37-month follow-up, all-cause death occurred in 21 patients (39%). On multivariable analysis, GWI <= 456 mmHg% was independently associated with an increased risk of all-cause mortality (hazard ratio, 2.882; 95% CI, 1.157-7.176; P = 0.023).ConclusionsHigh GWI assessed by speckle-tracking echocardiography and a non-invasively estimated LV pressure curve was independently associated with a favourable response to CRT and improved outcomes in patients with non-LBBB. The use of this non-invasive approach for quantifying myocardial variability and residual contractility can be beneficial for assessing CRT candidates and allow for more accurate patient stratification. Further, large multicentre studies are required to validate these findings.
引用
收藏
页码:2210 / 2224
页数:15
相关论文
共 50 条
[41]   Efficacy and safety of left bundle branch area pacing versus biventricular pacing in heart failure patients with left bundle branch block: study protocol for a randomised controlled trial [J].
Cheng, Liting ;
Zhang, Junmeng ;
Wang, Zefeng ;
Zhou, Mengge ;
Liang, Zhuo ;
Zhao, Lin ;
Chen, Jieruo ;
Wu, Yongquan .
BMJ OPEN, 2020, 10 (09)
[42]   The Implantation of Left Bundle Branch Area Pacing in Patients with and without Bundle Branch Block [J].
Chen, Tian-Ping ;
Shi, Xiao-Jun ;
Lu, Dong-Yu ;
Zhang, Heng .
JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN, 2021, 31 (11) :1268-1272
[43]   Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: a feasibility study in left bundle branch block [J].
Larsen, Camilla Kjellstad ;
Aalen, John M. ;
Stokke, Caroline ;
Fjeld, Jan Gunnar ;
Kongsgaard, Erik ;
Duchenne, Juergen ;
Degtiarova, Ganna ;
Gheysens, Olivier ;
Voigt, Jens-Uwe ;
Smiseth, Otto A. ;
Hopp, Einar .
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 2020, 21 (02) :143-153
[44]   QRS Voltage in Precordial Leads Predicts Survival After Cardiac Resynchronization Therapy in Non-Left Bundle Branch Block Patients [J].
Apetrei, Csilla-Andrea ;
Avram, Teodora ;
Sarb, Adriana Daniela ;
Zehan, Iulia ;
Moldovan, Madalina ;
Sorin, Pop ;
Gusetu, Gabriel ;
Mocanu, Lorena ;
Coseriu, Giorgia ;
Burde, Andrada .
CIRCULATION, 2023, 148
[45]   Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block [J].
Witt, Christoffer Tobias ;
Kronborg, Mads Brix ;
Nohr, Ellen Aagaard ;
Nielsen, Jens Cosedis .
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2016, 46 (03) :345-351
[46]   Does Cardiac Resynchronization Therapy Benefit Patients With Right Bundle Branch Block Left Ventricular Free Wall Pacing: Seldom Right for Right Bundle Branch Block [J].
Bilchick, Kenneth C. .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2014, 7 (03) :543-552
[47]   Cardiac Resynchronization Therapy for Non-Left Bundle Branch Block Time for Change? [J].
Qin, Dingxin ;
Singh, Jagmeet P. .
JACC-CLINICAL ELECTROPHYSIOLOGY, 2024, 10 (01) :27-30
[48]   Left axis deviation in patients with left bundle branch block is a marker of myocardial disease associated with poor response to cardiac resynchronization therapy [J].
Storkas, Hanne Stavo ;
Hansen, Thomas Fritz ;
Tahri, Jasmine Borg ;
Lauridsen, Trine Kiilerich ;
Olsen, Flemming Javier ;
Borgquist, Rasmus ;
Vinther, Michael ;
Lindhardt, Tommi Bo ;
Bruun, Niels Eske ;
Sogaard, Peter ;
Risum, Niels .
JOURNAL OF ELECTROCARDIOLOGY, 2020, 63 :147-152
[49]   Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta-analysis [J].
Hua, Juan ;
Wang, Chenxi ;
Kong, Qiling ;
Zhang, Yichu ;
Wang, Qijun ;
Xiong, Ziyi ;
Hu, Jinzhu ;
Li, Juxiang ;
Chen, Qi ;
Hong, Kui .
CLINICAL CARDIOLOGY, 2022, 45 (02) :214-223
[50]   Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study [J].
Chen, Xueying ;
Ye, Yang ;
Wang, Zhongkai ;
Jin, Qinchun ;
Qiu, Zhaohui ;
Wang, Jingfeng ;
Qin, Shengmei ;
Bai, Jin ;
Wang, Wei ;
Liang, Yixiu ;
Chen, Haiyan ;
Sheng, Xia ;
Gao, Feng ;
Zhao, Xianxian ;
Fu, Guosheng ;
Ellenbogen, Kenneth A. ;
Su, Yangang ;
Ge, Junbo .
EUROPACE, 2022, 24 (05) :807-816