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S17-4 ASSESSMENT OF RIGHT VENTRICULAR PACING-INDUCED GLOBAL LEFT VENTRICULAR MECHANICAL DYSSYNCHRONY BY REAL-TIME 3-D ECHOCARDIOGRAPHY
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Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
of MI allows suppression of ventricular arrhythmia (VPBs, mVT, PVT) in long term follow up.
S17-4 ASSESSMENT OF RIGHT VENTRICULAR PACING-INDUCED GLOBAL LEFT VENTRICULAR MECHANICAL DYSSYNCHRONY BY REAL-TIME 3-D ECHOCARDIOGRAPHY
Bih-Fang Guo, Wen-Hau Lieu, Morgan Fu, Kuo-Li Pang, Yung-Lon Chen. Chang Gung Memorial Hosptial-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan Right ventricular (RV) apex may not be an ideal position for pacing in patients who need permanent ventricular pacing because pacing at the RV apex can create ventricular dyssynchrony and impair ejection fraction. Alternate RV pacing sites have been attempted, but the results of pacing at these sites have been inconsistent. The inconsistent hemodynamic function may simply reflect varying degree of LV dyssynchrony induced by different RV pacing sites in individual patient. The purpose of this study was to compare global LV mechanical dyssynchrony during pacing to the RV apex and RV outflow septum in each individual patient using a real time three-dimensional echocardiography (RT3DE). Seven patients underwent RT3DE during AAI or DDD pacing with RV pacing lead positioned to the RV apex and RV outflow septum. The global and segmental left ventricular (LV) volumes were analyzed and a systolic dyssynchrony index (SDI), defined as the standard deviation (SD) of the timings of regional volumes reaching their minimum as a percentage of the cardiac cycle, was derived. SDI during AAI pacing was 4.4±2.4%. The corresponding values during RV apex and septal pacings were 7.2±3.4% (p=0.04 vs AAI) and 5.3±4.1% (p=0.52 vs AAI), respectively. RV septal pacing tended to have lower SDI as compared to RV apex pacing (p=0.16). LV ejection fraction was decreased during RV apex pacing (53±8%, p=0.011) and also tended to be less with RV septal pacing (53±9%, p=0.07), as compared with AAI pacing (60±7%). These results support the notion that RV septal pacing should be chosen for permanent RV pacing.
S17-5 PREVALENCE OF INTERVENTRICULAR AND INTRAVENTRICULAR DYSSYNCHRONY IN HEART FAILURE PATIENTS REGARDLESS QRS DURATION
Maryam Esmaeilzadeh, Nasser Mohammad Hadi, Zahra Emkanjoo, Anita Sadeghpour, Seyed Zahra M.Ojaghi Haghighi, Niloufar Samiei, Feridoun Noohi, Ahmad Mohebbi, Majid Maleki. Shaheed Rajaie Cardiovascular Medical Center, Tehran, Iran(IR) Background: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients. However some patients fail to respond to CRT. We sought to evaluate the presence of ventricular dyssynchrony in hear failure patients regardless QRS duration. Methods: 101 patients with severe heart failure (LVEF<35%, NYHA class III-IV) were evaluated prospectively using standard 12 leads electrocardiogram and complete comprehensive echocardiography including tissue Doppler imaging(TDI). Results: Based on QRS duration the patients divided into two groups. 48 (47.5%) patients had a normal QRS duration of ≤ 120 ms (Group I) and 53 (52.5%) had wide QRS duration (Group II).A greater proportion of patients with wide QRS duration had both interventricular and intraventricular dyssynchrony (30.2% in
Group II versus 4.2% in Group I, PV<0.001). The QRS duration had a relatively strong correlation with interventricular dyssynchrony, but not with intraventricular dyssynchrony (Fig. I). Conclusions: Although interventricular dyssynchrony is reliably assessed by TDI, however, in patients with severe heart failure and rocking heart left ventricular longitudinal dyssynchrony may not be changed significantly, so more sophisticated imaging techniques should be performed for evaluation of intraventricular dyssynchrony before CRT.
S17-6 MORPHOLOGICAL AND TOPOLOGICAL REMODELING OF THE LEFT ATRIUM IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS DELINEATED BY MULTIDETECTOR COMPUTED TOMOGRAPHY: IMPLICATIONS FOR LEFT ATRIAL INTERVENTIONS
Chih-Chieh Yu, Wen-Jeng Lee, Yi-Chih Wang, Ling-Ping Lai, Jiunn-Lee Lin. National Taiwan University Hospital, Taipei and Yun-lin, Taiwan ROC Background: Chronic systolic heart failure (SHF) is frequently exacerbated by paroxysmal or persistent atrial fibrillation (AF). Radiofrequency catheter ablation (RFA) targeting at the vulnerable left atrium (LA) might eliminate AF. However, unpredictable morphological and topological LA remodeling in chronic SHF could be challenging in RFA of AF. Methods: To delineate the in vivo anatomy, we investigated 25 patients (pts) of chronic SHF (NYHA function II-III, 17 male, 6 female, aged 63±12 yrs) and 23 matched normal control by cardiac multidetector computed tomography (MDCT). The mean ejection fraction of left ventricle (LV) in SHF group was 32±7% (range 17-40%) by echocardiography. Results: As shown in Table, end-diastolic and end-systolic volumes of LA (LAEDV, LAESV) in SHF pts were markedly dilated. The LA dilatation was more in horizontal (LADh) and anteroposterior (LADap) dimensions, compared to vertical (LADv). The maximal diameter (Dmax) of left superior and inferior pulmonary veins (LSPV & LIPV), but not of right superior or inferior veins (RSPV & RIPV), enlarged in SHF pts, while minimal diameter (Dmin) unchanged. The LA wall became thicker both in roof and posterior wall (PW), particularly near left-sided PVs. The mitral isthmus length (MI) between LIPV and mitral annulus was similar in both groups, whereas the LA-esophagus contact (LA-Eso) was significantly longer in SHF pts. Conclusions: The morphological and topological characteristics due to LA remodeling in SHF could be critical in AF catheter intervention. Table. LA anatomical characters
LAEDV (mm3 ) LAESV (mm3 ) LAEF (%) LA dimension (mm) LADh LADap LADv Dmax/Dmin (mm) LSPV LIPV RSPV RIPV LA wall thickness (mm) Roof (LSPV/RSPV) PW (LIPV/RIPV) LA-Eso (mm)
*P<0.05, @ P<0.01, † P<0.001.
Figure I: Comparison of inter- and intra ventricular dyssynchrony between two groups of patients.
SHF (n=25)
Normal (n=23)
124±40.1 85±41.6 34±15.6
80±18.8† 51±17.5† 37±10.7
56±8.0 66±8.4 60±7.7
45±8.0† 57±6.4† 56±6.3@
25±5.5/15±3.3 19±3.1/12±3.5 23±3.5/18±3.6 22±5.5/16±3.3
22±2.9*/15±3.1 17±2.0*/11±2.2 23±2.7/18±3.1 20±3.2/15±3.3
2.2±0.9/2.3±0.9 1.6±0.3/1.7±0.6 49±9.2
2.0±0.6/2.2±0.9 1.3±0.3@ /1.5±0.3 40±8.1*
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
of MI allows suppression of ventricular arrhythmia (VPBs, mVT, PVT) in long term follow up.
S17-4 ASSESSMENT OF RIGHT VENTRICULAR PACING-INDUCED GLOBAL LEFT VENTRICULAR MECHANICAL DYSSYNCHRONY BY REAL-TIME 3-D ECHOCARDIOGRAPHY
Bih-Fang Guo, Wen-Hau Lieu, Morgan Fu, Kuo-Li Pang, Yung-Lon Chen. Chang Gung Memorial Hosptial-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan Right ventricular (RV) apex may not be an ideal position for pacing in patients who need permanent ventricular pacing because pacing at the RV apex can create ventricular dyssynchrony and impair ejection fraction. Alternate RV pacing sites have been attempted, but the results of pacing at these sites have been inconsistent. The inconsistent hemodynamic function may simply reflect varying degree of LV dyssynchrony induced by different RV pacing sites in individual patient. The purpose of this study was to compare global LV mechanical dyssynchrony during pacing to the RV apex and RV outflow septum in each individual patient using a real time three-dimensional echocardiography (RT3DE). Seven patients underwent RT3DE during AAI or DDD pacing with RV pacing lead positioned to the RV apex and RV outflow septum. The global and segmental left ventricular (LV) volumes were analyzed and a systolic dyssynchrony index (SDI), defined as the standard deviation (SD) of the timings of regional volumes reaching their minimum as a percentage of the cardiac cycle, was derived. SDI during AAI pacing was 4.4±2.4%. The corresponding values during RV apex and septal pacings were 7.2±3.4% (p=0.04 vs AAI) and 5.3±4.1% (p=0.52 vs AAI), respectively. RV septal pacing tended to have lower SDI as compared to RV apex pacing (p=0.16). LV ejection fraction was decreased during RV apex pacing (53±8%, p=0.011) and also tended to be less with RV septal pacing (53±9%, p=0.07), as compared with AAI pacing (60±7%). These results support the notion that RV septal pacing should be chosen for permanent RV pacing.
S17-5 PREVALENCE OF INTERVENTRICULAR AND INTRAVENTRICULAR DYSSYNCHRONY IN HEART FAILURE PATIENTS REGARDLESS QRS DURATION
Maryam Esmaeilzadeh, Nasser Mohammad Hadi, Zahra Emkanjoo, Anita Sadeghpour, Seyed Zahra M.Ojaghi Haghighi, Niloufar Samiei, Feridoun Noohi, Ahmad Mohebbi, Majid Maleki. Shaheed Rajaie Cardiovascular Medical Center, Tehran, Iran(IR) Background: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients. However some patients fail to respond to CRT. We sought to evaluate the presence of ventricular dyssynchrony in hear failure patients regardless QRS duration. Methods: 101 patients with severe heart failure (LVEF<35%, NYHA class III-IV) were evaluated prospectively using standard 12 leads electrocardiogram and complete comprehensive echocardiography including tissue Doppler imaging(TDI). Results: Based on QRS duration the patients divided into two groups. 48 (47.5%) patients had a normal QRS duration of ≤ 120 ms (Group I) and 53 (52.5%) had wide QRS duration (Group II).A greater proportion of patients with wide QRS duration had both interventricular and intraventricular dyssynchrony (30.2% in
Group II versus 4.2% in Group I, PV<0.001). The QRS duration had a relatively strong correlation with interventricular dyssynchrony, but not with intraventricular dyssynchrony (Fig. I). Conclusions: Although interventricular dyssynchrony is reliably assessed by TDI, however, in patients with severe heart failure and rocking heart left ventricular longitudinal dyssynchrony may not be changed significantly, so more sophisticated imaging techniques should be performed for evaluation of intraventricular dyssynchrony before CRT.
S17-6 MORPHOLOGICAL AND TOPOLOGICAL REMODELING OF THE LEFT ATRIUM IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS DELINEATED BY MULTIDETECTOR COMPUTED TOMOGRAPHY: IMPLICATIONS FOR LEFT ATRIAL INTERVENTIONS
Chih-Chieh Yu, Wen-Jeng Lee, Yi-Chih Wang, Ling-Ping Lai, Jiunn-Lee Lin. National Taiwan University Hospital, Taipei and Yun-lin, Taiwan ROC Background: Chronic systolic heart failure (SHF) is frequently exacerbated by paroxysmal or persistent atrial fibrillation (AF). Radiofrequency catheter ablation (RFA) targeting at the vulnerable left atrium (LA) might eliminate AF. However, unpredictable morphological and topological LA remodeling in chronic SHF could be challenging in RFA of AF. Methods: To delineate the in vivo anatomy, we investigated 25 patients (pts) of chronic SHF (NYHA function II-III, 17 male, 6 female, aged 63±12 yrs) and 23 matched normal control by cardiac multidetector computed tomography (MDCT). The mean ejection fraction of left ventricle (LV) in SHF group was 32±7% (range 17-40%) by echocardiography. Results: As shown in Table, end-diastolic and end-systolic volumes of LA (LAEDV, LAESV) in SHF pts were markedly dilated. The LA dilatation was more in horizontal (LADh) and anteroposterior (LADap) dimensions, compared to vertical (LADv). The maximal diameter (Dmax) of left superior and inferior pulmonary veins (LSPV & LIPV), but not of right superior or inferior veins (RSPV & RIPV), enlarged in SHF pts, while minimal diameter (Dmin) unchanged. The LA wall became thicker both in roof and posterior wall (PW), particularly near left-sided PVs. The mitral isthmus length (MI) between LIPV and mitral annulus was similar in both groups, whereas the LA-esophagus contact (LA-Eso) was significantly longer in SHF pts. Conclusions: The morphological and topological characteristics due to LA remodeling in SHF could be critical in AF catheter intervention. Table. LA anatomical characters
LAEDV (mm3 ) LAESV (mm3 ) LAEF (%) LA dimension (mm) LADh LADap LADv Dmax/Dmin (mm) LSPV LIPV RSPV RIPV LA wall thickness (mm) Roof (LSPV/RSPV) PW (LIPV/RIPV) LA-Eso (mm)
*P<0.05, @ P<0.01, † P<0.001.
Figure I: Comparison of inter- and intra ventricular dyssynchrony between two groups of patients.
SHF (n=25)
Normal (n=23)
124±40.1 85±41.6 34±15.6
80±18.8† 51±17.5† 37±10.7
56±8.0 66±8.4 60±7.7
45±8.0† 57±6.4† 56±6.3@
25±5.5/15±3.3 19±3.1/12±3.5 23±3.5/18±3.6 22±5.5/16±3.3
22±2.9*/15±3.1 17±2.0*/11±2.2 23±2.7/18±3.1 20±3.2/15±3.3
2.2±0.9/2.3±0.9 1.6±0.3/1.7±0.6 49±9.2
2.0±0.6/2.2±0.9 1.3±0.3@ /1.5±0.3 40±8.1*