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(Circulation. 2004;110:66-73.)
© 2004 American Heart Association, Inc.
Original Articles |
From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong (C.-M.Y., J.W.-H.F., Q.Z., Y.-S.C., H.L., L.C.C.K., S.-L.K., Y.Z., J.E.S.), and the Department of Medicine, Alice Ho Miu Ling Nethersole Hospital (C.-K.C.), Hong Kong.
Correspondence to Professor Cheuk-Man Yu, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. E-mail cmyu{at}cuhk.edu.hk
Received June 17, 2003; de novo received September 13, 2003; revision received March 10, 2004; accepted March 17, 2004.
| Abstract |
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Methods and Results TDI and SRI were performed at baseline and 3-month follow-up. Eighteen parameters of intraventricular and interventricular asynchrony based on the time to peak myocardial contraction (Ts) and time to peak strain rate (Tsr) were compared, along with postsystolic shortening (PSS). Reverse remodeling with reduction of LV end-diastolic and end-systolic volumes and gain in ejection fraction (all P<0.001) was observed in the whole study population. The standard deviation of Ts of 12 LV segments (Ts-SD) is the most powerful predictor of reverse remodeling in both the ischemic (r=0.65, P<0.001) and nonischemic (r=0.79, P<0.001) groups. The PSS of 12 LV segments was a good predictor only for the nonischemic (r=0.64, P<0.001) but not the ischemic (r=0.32, P=NS) group. However, parameters of SRI and interventricular asynchrony failed to predict reverse remodeling. By multiple regression analysis, independent parameters included Ts-SD in both groups (P<0.005) and PSS of 12 LV segments in the nonischemic group (P=0.03). The area of the receiver operating characteristic curve was largest for Ts-SD (0.94; CI=0.88 to 1.00).
Conclusions Ts-SD is the most powerful predictor of LV reverse remodeling and was consistently useful for ischemic and nonischemic heart failure. However, PSS is useful only for nonischemic pathogenesis, whereas the role of SRI parameters was not supported by the present study.
Key Words: heart failure remodeling pacing echocardiography
| Introduction |
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| Methods |
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Biventricular Device Implantation
Biventricular devices were implanted as previously described.1,5 The LV pacing lead was inserted into either the lateral or posterolateral cardiac vein. Thirty-nine patients received an Attain system (model 2187, model 4189, model 4191 [side-wire lead], or model 4193 [over-the-wire]) (Medtronic Inc), and 15 received the Easytrak over-the-wire lead (model 4512, Guidant Inc). Apart from 4 patients who received biventricular cardiac defibrillators (InSync ICD or Contak CD), all the others received biventricular pacemakers (InSync, InSync III, or Contak TR). The atrioventricular interval was optimized by Ritters method with a mean value of 99.5±24.8 ms.
Echocardiography
Standard echocardiography, including Doppler studies, was performed (System 5 or Vivid 5, Vingmed-General Electric). The LV volumes and ejection fraction were assessed by biplane Simpsons equation using the apical 4-chamber and 2-chamber views. The intraobserver and interobserver variability for volumetric assessment was 4% and 5%, respectively. Cardiac output, rate of pressure rise in systole (dP/dt), and midsystolic mitral regurgitation were measured as previously described.4
TDI was performed using apical views for the long-axis motion of the ventricles as previously described.4,14,15 Two-dimensional echocardiography with TDI color imaging views (apical 4-chamber, 2-chamber, and long-axis views) were optimized for pulse repetition frequency, color saturation, sector size, and depth and were allowed the highest possible frame rate. At least 3 consecutive beats were stored, and the images were analyzed offline with the aid of a customized software package (EchoPac 6.3.6, Vingmed-General Electric). Myocardial velocity curves were reconstituted offline using the 6-basal and 6-midsegmental model in the LV as previously described.4,5 The peak myocardial velocity during the ejection phase (Sm) and the time to peak Sm (Ts) were measured with reference to QRS complex.4,5,16
The SRI data were processed from the TDI data.17 During data acquisition, to ensure the best-quality data, the narrowest image sector angle possible was used, with the lowest possible depth, to maintain the highest possible frame rate, typically >140 frames/s. The angle between the Doppler beam and the wall was keep at <30°. The strain rate can be estimated by calculating the velocity gradient between the 2 points17,18 with the equation: strain rate=(v[r]v[r+
r])/
r. An offset of
r=10 mm was used in all studies. Validation of TDI19 and SRI18 had been performed previously. In our laboratory, the intraobserver and interobserver variability for TDI was 3% and 5%, and SRI was 16% and 19%, respectively, after a serial measurement in 120 segments.
Parameters of systolic asynchrony based on TDI or SRI were correlated to the change in LV end-systolic volume.
Parameters for intraventricular asynchrony assessed by TDI include the following.
Standard deviation of Ts of the 12 LV segments (Ts-SD).
Maximal difference in Ts between any 2 of 12 LV segments (Ts-12).
Maximal difference in Ts between any 2 of 6 basal LV segments (Ts-6-basal).
Absolute difference in Ts between any medial wall and free wall segments in both basal and mid levels (Ts-med-free).
Absolute difference in Ts between basal medial wall and basal free wall segments (Ts-basal-med-free).
Absolute difference in Ts between the basal septal and basal lateral walls (Ts-sep-lat).
Absolute difference in Ts between the basal septal and basal posterior walls (Ts-sep-post).
For the last 2 parameters, medial wall refers to the septal and anteroseptal wall segments, and the free wall refers to the lateral and posterior wall segments.
The parameter that combined the use of TDI and SRI is the number of segments with PSS (or delay longitudinal contraction), ie, a positive velocity occurred after systole that was greater than the systolic peak during ejection phase, which was confirmed by SRI to be an active movement by the presence of a negative peak strain rate. Two parameters were derived: number of segments with PSS among the 6 basal and 6 mid LV segments (PSS-12) and number of segments with PSS among the 6 basal segments (PSS-6-basal).
In SRI, the time to peak systolic strain rate was assessed (Tsr). On this basis, parameters similar to that of TDI were assessed for intraventricular synchronicity. They included the following.
Standard deviation of Tsr of the 12 LV segments (Tsr-SD).
Maximal difference in Ts between any 2 of 6 basal and 6 mid LV segments (Tsr-12).
Maximal difference in Tsr between any 2 of 6 basal LV segments (Tsr-6-basal).
Absolute difference in Tsr between any medial wall and free wall segments (Tsr-med-free).
Absolute difference in Tsr between basal medial wall and basal free wall segments (Tsr-basal-med-free).
Absolute difference in Tsr between the basal septal and basal lateral walls (Tsr-sep-lat).
Absolute difference in Tsr between the basal septal and basal posterior walls (Tsr-sep-post).
For interventricular asynchrony, parameters measured included the following.
Absolute difference in Ts between the basal septal and basal right ventricular free wall (Ts-IVD).
Absolute difference in Tsr between the basal septal and basal right ventricular free wall (Tsr-IVD).
Statistics
For the comparison of parametric variables before and after CRT, paired-sample t test was used. The comparison of clinical and echocardiographic parameters between ischemic and nonischemic groups was performed by unpaired t test or Pearson
2 test where appropriate. Correlation analysis was used to compare the relationship between parameters of systolic asynchrony and the change of LV end-systolic volume after pacing in a univariate model, followed by multivariate analysis in a stepwise multiple regression model. Receiver operating characteristics (ROC) were analyzed for TDI and PSS parameters. All data were expressed as mean±SD. A probability value of P<0.05 was considered statistically significant.
| Results |
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Successful LV reverse remodeling was defined as a reduction of LV end-systolic volume (
LVVs) of >15%,5,9,20 which was observed in 31 patients (57%) after CRT for 3 months. The others were regarded as nonresponders who had a relatively stable
LVVs (between 15% and +15%) in 19 patients (35%) or the
LVVs was further enlarged >15% in 4 patients (8%). There was no difference in baseline clinical and echocardiographic parameters between responders and nonresponders of reverse remodeling (Table 1). However, improvement of ejection fraction was observed only in responders (25.3±9.5% versus 38.0±8.8%, P<0.001) but not the nonresponders (24.5±10.0% versus 26.6±10.1%, P=NS).
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Comparison of TDI, PSS, and SRI Parameters on the Prediction of Reverse Remodeling
As shown in Table 2, all the TDI parameters significantly predicted LV reverse remodeling. Among them, Ts-SD had the strongest predictive value (r=0.74, P<0.001). A good correlation was also observed when the 6 basal LV segments or all the LV segments (both r=0.60, P<0.001) were included into the model (Figure 1). The predictive values by other TDI parameters were significant but lower. The PSS and SRI parameters were unable to predict reverse remodeling (Figure 1). The parameters of interventricular asynchrony also failed to predict reverse remodeling. Furthermore, only responders of reverse remodeling showed significant improvement of most TDI parameters, which was worsening in the nonresponders. On stepwise multivariate regression analysis in which the significant parameters were entered into the statistical model, Ts-SD remained the only independent predictor of reverse remodeling response (ß=1.38; CI, 1.79 to 0.97). Other TDI parameters, including PSS and QRS duration, were unable to predict reverse remodeling.
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The ROC for parameters with significant correlation with reverse remodeling in the univariate model are shown in Table 2. The area under the curve was largest for Ts-SD (0.94, P<0.001) and was significant for all the other TDI parameters (Figure 2). On the basis of the data on the ROC curve, we concluded that a Ts-SD value of 31.4 ms has a sensitivity of 96% and a specificity of 78% to predict significant reverse remodeling.
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Predictive Values of TDI, PSS, and SRI for Reverse Remodeling in Ischemic and Nonischemic Heart Failure
The baseline clinical and echocardiographic features were similar between ischemic and nonischemic groups (Table 3). The degree of prepacing systolic asynchrony, as shown by Ts-SD and PSS-12, was similar between the 2 groups. Three months after CRT, the reduction of LV volume and gain in ejection fraction were also comparable between the 2 groups. In the ischemic group, 13 of 22 patients (59%) had significant reverse remodeling, and this proportion was comparable to the nonischemic group (18 of 32 patients [56%];
2=0.28, P=NS).
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In the ischemic group, the predictive values of TDI parameters were in general lower than in patients with nonischemic pathogenesis (Table 2 and Figures 1 and 3
). In ischemic patients, the best predictor was Ts-SD (r=0.65, P=0.001). However, this was decreased precipitously for other TDI parameters, especially Ts-12 and Ts-6-basal (r=0.46 to 0.43). The parameters by PSS, SRI, and interventricular delay were unable to predict reverse remodeling. In the stepwise multivariate analysis model, Ts-SD was the only independent predictor of reverse remodeling (ß=1.37; CI, 2.22 to 0.53; P=0.003).
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In the nonischemic group, there were 3 TDI parameters that correlated closely with reverse remodeling: Ts-SD was an excellent predictor (r=0.79, P<0.001), followed by Ts-12 (r=0.72, P<0.001) and Ts-6-basal (r=0.69, P<0.001). Interestingly, PSS-12 and PSS-6-basal in the nonischemic group is a reasonably reliable predictor of reverse remodeling (r=0.64 to 0.66, both P<0.001). None of the parameters of SRI or interventricular delay predicted reverse remodeling. By stepwise multivariate analysis model, the 2 independent predictors of reverse remodeling were Ts-SD (ß=1.09; CI, 1.59 to 0.59; P<0.001) and PSS-12 (ß=2.90; CI, 5.43 to 0.38; P=0.03).
| Discussion |
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Clinical and volumetric nonresponders to CRT are consistently observed in approximately one third of patients.2,5,9 Recent efforts were envisaged to search for echocardiographic predictors of response, in which TDI plays a vital role.4,1012 An early study observed that Ts-SD, the systolic asynchrony index, was a powerful predictor of LV reverse remodeling and was able to identify responders.5 Studies also observed that volumetric responders were associated with clinical improvements.5,11 The technique of TDI was also combined with SRI to search for PSS, or delayed longitudinal contraction.10,23 The presence of PSS in the basal LV segments was found to correlate with the gain in ejection fraction in 25 patients receiving CRT.10 In that study, ejection fraction (but not volumetric data) was used as an indicator of reverse remodeling.10 The septoposterior wall by M-mode measurement was observed to predict reverse remodeling in 20 patients, of whom the majority (n=16) had a nonischemic pathogenesis.9 Very recently, the assessment of strain has also been suggested to be useful to assess mechanical events in the ventricle.24 The present study is the largest prospective study that used TDI, PSS, and SRI to assess cardiac intraventricular and interventricular asynchrony for patients receiving CRT and in a balanced number of patients with ischemic and nonischemic causes. The results demonstrated that TDI parameters closely predict LV reverse remodeling and that Ts-SD (the "asynchrony index") is the single best predictor. This parameter encompasses information of all the 12 LV segments and reflects systolic asynchrony even if the pattern is more heterogeneous. Furthermore, the more segments analyzed, the higher the predictive value.
In this study, PSS is a very weak predictor of reverse remodeling. The PSS actually described a contractile response observed during early diastole after closure of the aortic valve.23 Therefore, it is a semiquantitative and indirect marker of systolic asynchrony. Furthermore, occurrence of PSS has been described in normal subjects who had no evidence of cardiac disease.23 Also, none of the SRI parameters predict reverse remodeling. Tsr reflects the time to peak regional deformation by contractile force and theoretically will be affected by asynchronous contraction but not affected by translational movement. However, such benefit may be offset by the relatively large interobserver and intraobserver variability (at least >16%).24
Role of TDI, PSS, and SRI in Ischemic and Nonischemic Heart Failure
In this study, the asynchrony index, Ts-SD, is the strongest independent predictor of LV reverse remodeling for both groups. Interestingly, the predictive values of all the TDI parameters were consistently higher in the nonischemic than the ischemic group. The discrepancy of predictive values with different causes of heart failure may be related to the more heterogeneous pattern of systolic asynchrony in patients with an ischemic pathogenesis.10 Unlike patients with nonischemic pathogenesis of heart failure, in whom there is a dominant pattern of relative mechanical delay between the septal and free wall regions, systolic asynchrony in ischemic cardiomyopathy may occur in any region of the LV, depending on the vascular territory of ischemia or infarction.25 As a result, placement of the LV lead in the lateral or posterolateral vein of the coronary sinus in these patients may not be optimal if delay is not at the free wall region. Another interesting observation is that the predictive value of PSS was good only for the nonischemic group. In the ischemic group, PSS may not be a marker of systolic asynchrony but may represent myocardial ischemia18 or viability.26 In these situations, CRT may not have altered the occurrence of PSS. We suggest that evaluation of systolic asynchrony by PSS also needs to consider the pathogenesis of heart failure.
Limitations of the Study
The study was conducted by relatively dated echocardiographic instruments that were acquired a few years ago. Although the current state-of-the-art machine may not significantly enhance the image quality of TDI, the better hardware and software equipment may improve the signal-to-noise ratio of SRI and its predictive value. Mitral regurgitation was assessed only by the change in jet area relative to left atrial area. The use of more complex methods, such as the proximal isovelocity surface area method, is preferable for accurate quantitative assessment of its severity.
Conclusions
As an important and objective marker of response to CRT, LV reverse remodeling occurs only in the majority of patients, not in all, after CRT. Direct assessment of systolic asynchrony by Ts-SD provides strong and independent predictive value of reverse remodeling of both ischemic and nonischemic causes. The semiquantitative evaluation of PSS-12 is potentially useful for nonischemic but not ischemic patients.
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C. Miyazaki, G. Lin, B. D. Powell, R. E. Espinosa, C. J. Bruce, F. A. Miller Jr, B. L. Karon, R. F. Rea, D. L. Hayes, and J. K. Oh Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes Circ Cardiovasc Imaging, July 1, 2008; 1(1): 14 - 22. [Abstract] [Full Text] [PDF] |
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M. K. Friedberg, S. L. Roche, A. F. Mohammed, M. Balasingam, E. G. Atenafu, and P. F. Kantor Left Ventricular Diastolic Mechanical Dyssynchrony and Associated Clinical Outcomes in Children With Dilated Cardiomyopathy Circ Cardiovasc Imaging, July 1, 2008; 1(1): 50 - 57. [Abstract] [Full Text] [PDF] |
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J. Abraham and T. P. Abraham Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?: Echocardiography Is Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available Circ Cardiovasc Imaging, July 1, 2008; 1(1): 79 - 85. [Full Text] [PDF] |
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A. H.M. Jansen, F. Bracke, J. m. van Dantzig, K. H. Peels, J. C. Post, H. C.M. van den Bosch, B. van Gelder, A. Meijer, H. H.M. Korsten, J. de Vries, et al. The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy Eur J Echocardiogr, July 1, 2008; 9(4): 483 - 488. [Abstract] [Full Text] [PDF] |
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E. S. Chung, A. R. Leon, L. Tavazzi, J.-P. Sun, P. Nihoyannopoulos, J. Merlino, W. T. Abraham, S. Ghio, C. Leclercq, J. J. Bax, et al. Results of the Predictors of Response to CRT (PROSPECT) Trial Circulation, May 20, 2008; 117(20): 2608 - 2616. [Abstract] [Full Text] [PDF] |
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C. Miyazaki, B. D. Powell, C. J. Bruce, R. E. Espinosa, M. M. Redfield, F. A. Miller, D. L. Hayes, Y.-M. Cha, and J. K. Oh Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block Circulation, May 20, 2008; 117(20): 2617 - 2625. [Abstract] [Full Text] [PDF] |
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L. J. Anderson, C. Miyazaki, G. R. Sutherland, and J. K. Oh Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy Circulation, April 15, 2008; 117(15): 2009 - 2023. [Full Text] [PDF] |
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S. Chattopadhyay, M. F. Alamgir, N. P. Nikitin, A. G. Fraser, A. L. Clark, and J. G.F. Cleland The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction Eur J Heart Fail, April 1, 2008; 10(4): 412 - 420. [Abstract] [Full Text] [PDF] |
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B. W.L. De Boeck, M. Meine, G. E. Leenders, A. J. Teske, H. van Wessel, J. H. Kirkels, F. W. Prinzen, P. A. Doevendans, and M. J. Cramer Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy Eur J Heart Fail, March 1, 2008; 10(3): 281 - 290. [Abstract] [Full Text] [PDF] |
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J. van Dijk, P. Knaapen, I.K. Russel, T. Hendriks, C.P. Allaart, C.C. de Cock, and O. Kamp Mechanical dyssynchrony by 3D echo correlates with acute haemodynamic response to biventricular pacing in heart failure patients Europace, January 1, 2008; 10(1): 63 - 68. [Abstract] [Full Text] [PDF] |
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J. van Dijk, P. A. Dijkmans, M. J.W. Gotte, M. D. Spreeuwenberg, C. A. Visser, and O. Kamp Evaluation of global left ventricular function and mechanical dyssynchrony in patients with an asymptomatic left bundle branch block: a real-time 3D echocardiography study Eur J Echocardiogr, January 1, 2008; 9(1): 40 - 46. [Abstract] [Full Text] [PDF] |
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C. Leclercq, G. B. Bleeker, C. Linde, E. Donal, J. J. Bax, M. J. Schalij, and C. Daubert Cardiac resynchronization therapy: clinical results and evolution of candidate selection Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I94 - I106. [Abstract] [Full Text] [PDF] |
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T. P. Abraham, V. L. Dimaano, and H.-Y. Liang Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice Circulation, November 27, 2007; 116(22): 2597 - 2609. [Full Text] [PDF] |
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A. D'Andrea, P. Caso, S. Romano, R. Scarafile, L. Riegler, G. Salerno, G. Limongelli, G. Di Salvo, P. Calabro, L. Del Viscovo, et al. Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study Eur. Heart J., November 2, 2007; 28(22): 2738 - 2748. [Abstract] [Full Text] [PDF] |
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K. Yoshida, Y. Seo, H. Yamasaki, K. Tanoue, N. Murakoshi, T. Ishizu, Y. Sekiguchi, S. Kawano, S. Otsuka, S. Watanabe, et al. Effect of triangle ventricular pacing on haemodynamics and dyssynchrony in patients with advanced heart failure: a comparison study with conventional bi-ventricular pacing therapy Eur. Heart J., November 1, 2007; 28(21): 2610 - 2619. [Abstract] [Full Text] [PDF] |
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G. B Bleeker, C.-M. Yu, P. Nihoyannopoulos, J. de Sutter, N. Van de Veire, E. R Holman, M. J Schalij, E. E van der Wall, and J. J Bax Optimal use of echocardiography in cardiac resynchronisation therapy Heart, November 1, 2007; 93(11): 1339 - 1350. [Abstract] [Full Text] [PDF] |
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L. Johnson, H. K. Kim, M. Tanabe, J. Gorcsan, D. Schwartzman, S. G. Shroff, and M. R. Pinsky Differential effects of left ventricular pacing sites in an acute canine model of contraction dyssynchrony Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H3046 - H3055. [Abstract] [Full Text] [PDF] |
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J. Gorcsan III, M. Tanabe, G. B. Bleeker, M. S. Suffoletto, N. C. Thomas, S. Saba, L. F. Tops, M. J. Schalij, and J. J. Bax Combined Longitudinal and Radial Dyssynchrony Predicts Ventricular Response After Resynchronization Therapy J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1476 - 1483. [Abstract] [Full Text] [PDF] |
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A. Vitarelli, P. Franciosa, and S. Rosanio Tissue Doppler Imaging in the assessment of selection and response from cardiac resynchronization therapy Eur J Echocardiogr, October 1, 2007; 8(5): 309 - 316. [Abstract] [Full Text] [PDF] |
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A. Sirker, M. Thomas, S. Baker, J. Shrimpton, S. Jewell, L. Lee, R. Rankin, V. Griffiths, N. Cooter, R. James, et al. Cardiac resynchronization therapy: left or left-and-right for optimal symptomatic effect the LOLA ROSE study Europace, October 1, 2007; 9(10): 862 - 868. [Abstract] [Full Text] [PDF] |
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Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Europace, October 1, 2007; 9(10): 959 - 998. [Full Text] [PDF] |
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M. I Burgess, C. Jenkins, J. Chan, and T. H Marwick Measurement of left ventricular dyssynchrony in patients with ischaemic cardiomyopathy: a comparison of real-time three-dimensional and tissue Doppler echocardiography Heart, October 1, 2007; 93(10): 1191 - 1196. [Abstract] [Full Text] [PDF] |
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D. A. Kass Highlighting the R in CRT Circulation, September 25, 2007; 116(13): 1434 - 1436. [Full Text] [PDF] |
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G. B. Bleeker, S. A. Mollema, E. R. Holman, N. Van De Veire, C. Ypenburg, E. Boersma, E. E. van der Wall, M. J. Schalij, and J. J. Bax Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy: Analysis in Patients With Echocardiographic Evidence of Left Ventricular Dyssynchrony at Baseline Circulation, September 25, 2007; 116(13): 1440 - 1448. [Abstract] [Full Text] [PDF] |
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Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Eur. Heart J., September 2, 2007; 28(18): 2256 - 2295. [Full Text] [PDF] |
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J. Madaric, M. Vanderheyden, C. Van Laethem, K. Verhamme, A. Feys, M. Goethals, S. Verstreken, P. Geelen, M. Penicka, B. De Bruyne, et al. Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance Eur. Heart J., September 1, 2007; 28(17): 2134 - 2141. [Abstract] [Full Text] [PDF] |
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P. Lim, C. Bars, L. Mitchell-Heggs, C. Roiron, N. Elbaz, B. Hamdaoui, N. Lellouche, J.-L. Dubois-Rande, and P. Gueret Importance of contractile reserve for CRT Europace, September 1, 2007; 9(9): 739 - 743. [Abstract] [Full Text] [PDF] |
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R. Lenarczyk, O. Kowalski, T. Kukulski, M. Szulik, P. Pruszkowska-Skrzep, T. Zielinska, J. Kowalczyk, S. Pluta, A. Duszanska, B. Sredniawa, et al. Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study Europace, September 1, 2007; 9(9): 762 - 767. [Abstract] [Full Text] [PDF] |
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C.-M. Yu, F. Fang, Q. Zhang, G. W.K. Yip, C. M. Li, J. Y.-S. Chan, L. Wu, and J. W.-H. Fung Improvement of Atrial Function and Atrial Reverse Remodeling After Cardiac Resynchronization Therapy for Heart Failure J. Am. Coll. Cardiol., August 21, 2007; 50(8): 778 - 785. [Abstract] [Full Text] [PDF] |
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A. K.Y. Chan, J. E. Sanderson, T. Wang, W. Lam, G. Yip, M. Wang, Y.-Y. Lam, Y. Zhang, L. Yeung, E. B. Wu, et al. Aldosterone Receptor Antagonism Induces Reverse Remodeling When Added to Angiotensin Receptor Blockade in Chronic Heart Failure J. Am. Coll. Cardiol., August 14, 2007; 50(7): 591 - 596. [Abstract] [Full Text] [PDF] |
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U. Wisloff, A. Stoylen, J. P. Loennechen, M. Bruvold, O. Rognmo, P. M. Haram, A. E. Tjonna, J. Helgerud, S. A. Slordahl, S. J. Lee, et al. Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients: A Randomized Study Circulation, June 19, 2007; 115(24): 3086 - 3094. [Abstract] [Full Text] [PDF] |
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C.-M. Yu, J. E. Sanderson, T. H. Marwick, and J. K. Oh Tissue Doppler Imaging: A New Prognosticator for Cardiovascular Diseases J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1903 - 1914. [Abstract] [Full Text] [PDF] |
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A. D'Andrea, P. Caso, S. Cuomo, R. Scarafile, G. Salerno, G. Limongelli, G. Di Salvo, S. Severino, L. Ascione, P. Calabro, et al. Effect of dynamic myocardial dyssynchrony on mitral regurgitation during supine bicycle exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy and 'narrow' QRS Eur. Heart J., April 2, 2007; 28(8): 1004 - 1011. [Abstract] [Full Text] [PDF] |
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J. W H Fung, J. Y S Chan, G. W K Yip, H. C K Chan, W. W L Chan, Q. Zhang, and C.-M. Yu Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy Heart, April 1, 2007; 93(4): 432 - 437. [Abstract] [Full Text] [PDF] |
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J.K. Oh Echocardiography in heart failure: Beyond diagnosis Eur J Echocardiogr, January 1, 2007; 8(1): 4 - 14. [Full Text] [PDF] |
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J. A. White, R. Yee, X. Yuan, A. Krahn, A. Skanes, M. Parker, G. Klein, and M. Drangova Delayed Enhancement Magnetic Resonance Imaging Predicts Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Dyssynchrony J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1953 - 1960. [Abstract] [Full Text] [PDF] |
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C.-M. Yu, Q. Zhang, G. W.K. Yip, P.-W. Lee, L. C.C. Kum, Y.-Y. Lam, and J. W.-H. Fung Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure: A Common but Ignored Condition J. Am. Coll. Cardiol., October 31, 2006; (2006) j.jacc.2006.10.022v1. [Abstract] [Full Text] [PDF] |
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J. E. Sanderson Systolic and Diastolic Ventricular Dyssynchrony in Systolic and Diastolic Heart Failure J. Am. Coll. Cardiol., October 31, 2006; (2006) j.jacc.2006.10.024v1. [Full Text] [PDF] |
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J. E. Sanderson Assessment of ventricular dyssynchrony: global or regional function? Eur. Heart J., October 2, 2006; 27(20): 2380 - 2381. [Full Text] [PDF] |
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E. C. Stecker, M. Zargarian, V. Dogra, B. T. John, J. Kron, J. H. McAnulty, and S. S. Chugh Native QRS duration predicts the occurrence of arrhythmic events in ICD recipients Europace, October 1, 2006; 8(10): 859 - 862. [Abstract] [Full Text] [PDF] |
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C-M Yu, Q Zhang, Y-S Chan, C-K Chan, G W K Yip, L C C Kum, E B Wu, P-W Lee, Y-Y Lam, S Chan, et al. Tissue Doppler velocity is superior to displacement and strain mapping in predicting left ventricular reverse remodelling response after cardiac resynchronisation therapy Heart, October 1, 2006; 92(10): 1452 - 1456. [Abstract] [Full Text] [PDF] |
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S. Lafitte, P. Bordachar, M. Lafitte, S. Garrigue, S. Reuter, P. Reant, K. Serri, V. Lebouffos, M. Berrhouet, P. Jais, et al. Dynamic Ventricular Dyssynchrony: An Exercise-Echocardiography Study J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2253 - 2259. [Abstract] [Full Text] [PDF] |
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Q. Zhang, J. W.-H. Fung, A. Auricchio, J. Y.-S. Chan, L. C.C. Kum, L. W. Wu, and C.-M. Yu Differential change in left ventricular mass and regional wall thickness after cardiac resynchronization therapy for heart failure Eur. Heart J., June 2, 2006; 27(12): 1423 - 1430. [Abstract] [Full Text] [PDF] |
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N. M. Hawkins, M. C. Petrie, M. R. MacDonald, K. J. Hogg, and J. J.V. McMurray Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony? Eur. Heart J., June 1, 2006; 27(11): 1270 - 1281. [Abstract] [Full Text] [PDF] |
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D. Mele, G. Pasanisi, F. Capasso, A. De Simone, M.-A. Morales, D. Poggio, A. Capucci, G. Tabacchi, L. Sallusti, and R. Ferrari Left intraventricular myocardial deformation dyssynchrony identifies responders to cardiac resynchronization therapy in patients with heart failure Eur. Heart J., May 1, 2006; 27(9): 1070 - 1078. [Abstract] [Full Text] [PDF] |
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T. H. Marwick Measurement of Strain and Strain Rate by Echocardiography: Ready for Prime Time? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1313 - 1327. [Abstract] [Full Text] [PDF] |
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G B Bleeker, P Steendijk, E R Holman, C-M Yu, O A Breithardt, T A M Kaandorp, M J Schalij, E E van der Wall, P Nihoyannopoulos, and J J Bax Assessing right ventricular function: the role of echocardiography and complementary technologies Heart, April 1, 2006; 92(suppl_1): i19 - i26. [Full Text] [PDF] |
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C. Y. Ho and S. D. Solomon A Clinician's Guide to Tissue Doppler Imaging Circulation, March 14, 2006; 113(10): e396 - e398. [Full Text] [PDF] |
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F. A Flachskampf and J.-U. Voigt Echocardiographic methods to select candidates for cardiac resynchronisation therapy. Heart, March 1, 2006; 92(3): 424 - 429. [Full Text] [PDF] |
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G. B. Bleeker, T. A.M. Kaandorp, H. J. Lamb, E. Boersma, P. Steendijk, A. de Roos, E. E. van der Wall, M. J. Schalij, and J. J. Bax Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy Circulation, February 21, 2006; 113(7): 969 - 976. [Abstract] [Full Text] [PDF] |
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M. S. Suffoletto, K. Dohi, M. Cannesson, S. Saba, and J. Gorcsan III Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy Circulation, February 21, 2006; 113(7): 960 - 968. [Abstract] [Full Text] [PDF] |
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S Ellery, L Williams, and M Frenneaux Role of resynchronisation therapy and implantable cardioverter defibrillators in heart failure Postgrad. Med. J., January 1, 2006; 82(963): 16 - 23. [Abstract] [Full Text] [PDF] |
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J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al. Cardiac Resynchronization Therapy: Part 1--Issues Before Device Implantation J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2153 - 2167. [Abstract] [Full Text] [PDF] |
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G. M. Marcus, E. Rose, E. M. Viloria, J. Schafer, T. De Marco, L. A. Saxon, E. Foster, and for the VENTAK CHF/CONTAK-CD Biventricular Pacing Septal to Posterior Wall Motion Delay Fails to Predict Reverse Remodeling or Clinical Improvement in Patients Undergoing Cardiac Resynchronization Therapy J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2208 - 2214. [Abstract] [Full Text] [PDF] |
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J. J.M. Zwanenburg, M. J.W. Gotte, J. T. Marcus, J. P.A. Kuijer, P. Knaapen, R. M. Heethaar, and A. C. van Rossum Propagation of Onset and PeakTime of Myocardial Shortening in Time of Myocardial Shortening in Ischemic Versus Nonischemic Cardiomyopathy: Assessment by Magnetic Resonance Imaging Myocardial Tagging J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2215 - 2222. [Abstract] [Full Text] [PDF] |
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S. Fukuda, R. Grimm, J.-M. Song, T. Kihara, M. Daimon, D. A. Agler, B. L. Wilkoff, A. Natale, J. D. Thomas, and T. Shiota Electrical Conduction Disturbance Effects on Dynamic Changes of Functional Mitral Regurgitation J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2270 - 2276. [Abstract] [Full Text] [PDF] |
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