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MIBI Scintigraphy Could Be Useful to Identify Heart Failure Patients with Narrow QRS Who Respond to Cardiac Resynchronization Therapy
S170 Journal of Cardiac Failure Vol. 19 No. 10S October 2013 immotile cardiac events, and apical HCM showed relatively better prognosis in Japanese.
P-077 Left Ventricular Systolic Circumferential Deformation is Associated with Left Ventricular Diastolic Apical Suction TAKAHIRO OHARA1, HIROYUKI IWANO2, MIN PU2, BRETT MEYERS3, CHARONKO JOHN3, PAVLOS VLACHOS3, WILLIAM LITTLE2 1 The Division of Cardiology and CCU, National Cerebral and Cardiovascular Center, 2 Cardiology Section, Wake Forest School of Medicine, 3Department of Mechanical Engineering, Virginia Tech Background: Early diastolic left ventricular (LV) filling results from an intraventricular pressure difference (IVPD) extending from the left atrium to the LV apex reflecting left ventricular suction. We hypothesized that myocardial deformation during systole is associated with LV suction. Methods: Color M mode Doppler (CMMD) images in the apical four chamber view were obtained. Mid to apical IVPG were calculated using the CMMD data to integrate the Euler equation. Myocardial deformation indexes were calculated using 2D speckle tracking technique. Results: We studied consecutive 15 patients referred for echocardiography (Age 56616 yearold, 6 male). Ejection fraction was 45615%. Mid to apical IVPD was correlated with peak global circumferential strain (Figure), but not with other systolic and diastolic longitudinal deformation indexes. Conclusion: LV systolic circumferential deformation is associated with LV apical suction.
P-080 MIBI Scintigraphy Could Be Useful to Identify Heart Failure Patients with Narrow QRS Who Respond to Cardiac Resynchronization Therapy MAKOTO NAKANO, KOJI FUKUDA, YUJI WAKAYAMA, MASATERU KONDO, YUHI HASEBE, HIROYUKI SATAKE, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Background: Indication of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with narrow QRS remains controversial. We examined whether MIBI scintigraphy is useful to identify such patients. Methods and Results: Patients treated with CRT were divided into 2 groups according to the width of QRS; wide QRS (QRS$150msec, wQRS, n579) and narrow QRS (QRS!!, nQRS, n541). LVESV and wall thickness (WT) were evaluated by MIBI scintigraphy before and 6 month after CRT. Difference in WT in the lateral wall to the septum was used as dyssynchrony index (Xwt). Reverse remodeling was defined as more than 10% decrease in LVESV and major adverse cardiac event (MACE) was evaluated by Kaplan-Meyer method after CRT. The prevalence of patients with reverse remodeling was significantly lower in the nQRS than in the wQRS group (42% vs. 77%, P! 0.05) and MACE-rate was significantly higher in the nQRS than in the wQRS group (P!0.05). Xwt before CRT was significantly less in the nQRS than in the wQRS group (7641 vs. 52661, P!0.001). However, MACE-rate in nQRS patients with Xwt$16.5, which was cut-off value of Xwt before CRT obtained by ROC curve, was similar to that in wQRS patients. Conclusions: These results indicate that evaluation of dyssynchrony by MIBI scintigraphy is useful to identify patients with nQRS who could respond to CRT.
P-081 The Long Term Clinical Outcome after Cardiac Resynchronization Therapy in Our Hospital HARUKO WADA, KAZUNORI KASHIWASE, MAYU NISHIO, YASUNORI UEDA Cardiovascular Devision, Osaka Police Hospital
P-078 Impact of Aortic Arch Plaques and Risk of Heart Failure in Patients with Atrial Fibrillation: A Transesophageal Echocardiographic Study NOBUHIDE WATANABE1, SAKI ITO1, KAZUTO YAMAGUCHI2, TOMOKO ADACHI1, NOBUYUKI TAKAHASHI1, HIROYUKI YOSHITOMI2, KAZUAKI TANABE1 1 Cardiology, Shimane University Hospital, 2Clinical Laboratory Department, Shimane University Hospital Background: Atrial fibrillation (AF) and heart failure have emerged as new cardiovascular epidemics. Heart failure with preserved left ventricular ejection fraction, including patients with AF, is recently characterized by systolic-ventricular and arterial stiffening and adverse coupling between the systems. Atherosclerotic aortic plaques $4.0 mm is prognostic predictors of cardiovascular events. The aim of this study was to evaluate impact of large and complex aortic plaques on cardiovascular events, especially heart failure in patients with AF. Methods and Results: 90 patients with AF (mean age: 67611.9 years old) were enrolled. Patients were grouped according to the presence (n536) or absence (n554) of aortic plaques $4.0 mm by transesophageal echocardiography (TEE). Cardiovascular events, including death, myocardial infarction, ischemic stroke, and admission with worsening of congestive heart failure (CHF), were no significant relationships between left ventricular ejection fraction, mitral inflow E/A, tissue doppler E/Ea, left atrial (LA) dense spontaneous echo contrast and LA appendage flow velocities, during a mean follow-up period of 1.9 years. The contribution of risk factors other than age is insignificant. Aortic plaques $4.0 mm by TEE was significantly associated with the worsening of CHF (p50.021). Coclusions: In patients with AF, thick and complex aortic plaques related to arterial stiffness and compliance, may be a significant predictor of the subsequent worsening of CHF. This finding may help therapeutic focus.
Background: In many reports, responders and non-responders were determined by echocardiographic parameters 6 months after cardiac resynchronization therapy (CRT), but there were limited data about the long term clinical outcome after CRT. Methods: We analyzed consecutive 38 patients implanted with a CRT defibrillator between September 2006 and May 2010 in this study. Echocardiography was repeated before and 6 months after implantation. The patients were followed for an average of 1360 (46-2438) days. Results: One patient died within 6 months. Ten patients (26%) were classified as responders (decrease $15% in LVESV), 27 patients (71%) as non-responders (decrease !15% or increase in LVESV). All-cause mortality was 40% in responders (n54) and 46% in non-responders (n513). In responders LVEDV and LVESV before implantation in dead patients were larger than living patients (LVEDV: 319 6 34.2 mL vs. 246 6 35.1 mL, p!0.05, LVESV: 241 6 39.2 mL vs. 160 6 39.3 mL, p!0.05). On the other hand, in non-responders there were no significant differences in LVEDV and LVESV between dead and living patients (LVEDV: 268 6 78.7 mL vs. 248 6 84.6 mL, p5NS, LVESV: 191 6 80.0 mL vs. 170 6 81.0 mL, p5NS). Conclusion: Patients with advanced LV remodeling, even if they are CRT responders, have a poor prognosis. Earlier CRT implantation may prevent LV remodeling and improve outcome.
P-082 Reverse Remodeling after Cardiac Resynchronization Therapy for Idiopathic Dilated Cardiomyopathy: A Case Report TADATSUGU GAMOU, KENJI SAKATA, NOBORU FUJINO, MASAKAZU YAMAGISHI Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine Background: The efficacy of cardiac resynchronization therapy in heart failure with extremely dilated left ventricle has not been fully reported. Case Report: The patient was a 46-year-old man who had developed heart failure. Trans-thoracic echocardiography revealed a severely dilated left ventricle with decreased left ventricular ejection fraction while Tissue Doppler echocardiography showed a significant intraventricular mechanical dyssynchrony. He was diagnosed with idiopathic dilated cardiomyopathy. He failed to recover despite optimal medication included in intravenous inotropic support. After cardiac resynchronization therapy, he was able to be weaned from inotropic support, New York Heart Association class improved from III to I, left ventricular diastolic dimension decreased from 96 to 70 mm, and blood level of brain natriuretic peptide decreased from 514 to 57 pg/ml. Conclusion: Cardiac resynchronization therapy was useful in an idiopathic dilated cardiomyopathy patient with a severely dilated left ventricle.
P-077 Left Ventricular Systolic Circumferential Deformation is Associated with Left Ventricular Diastolic Apical Suction TAKAHIRO OHARA1, HIROYUKI IWANO2, MIN PU2, BRETT MEYERS3, CHARONKO JOHN3, PAVLOS VLACHOS3, WILLIAM LITTLE2 1 The Division of Cardiology and CCU, National Cerebral and Cardiovascular Center, 2 Cardiology Section, Wake Forest School of Medicine, 3Department of Mechanical Engineering, Virginia Tech Background: Early diastolic left ventricular (LV) filling results from an intraventricular pressure difference (IVPD) extending from the left atrium to the LV apex reflecting left ventricular suction. We hypothesized that myocardial deformation during systole is associated with LV suction. Methods: Color M mode Doppler (CMMD) images in the apical four chamber view were obtained. Mid to apical IVPG were calculated using the CMMD data to integrate the Euler equation. Myocardial deformation indexes were calculated using 2D speckle tracking technique. Results: We studied consecutive 15 patients referred for echocardiography (Age 56616 yearold, 6 male). Ejection fraction was 45615%. Mid to apical IVPD was correlated with peak global circumferential strain (Figure), but not with other systolic and diastolic longitudinal deformation indexes. Conclusion: LV systolic circumferential deformation is associated with LV apical suction.
P-080 MIBI Scintigraphy Could Be Useful to Identify Heart Failure Patients with Narrow QRS Who Respond to Cardiac Resynchronization Therapy MAKOTO NAKANO, KOJI FUKUDA, YUJI WAKAYAMA, MASATERU KONDO, YUHI HASEBE, HIROYUKI SATAKE, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Background: Indication of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with narrow QRS remains controversial. We examined whether MIBI scintigraphy is useful to identify such patients. Methods and Results: Patients treated with CRT were divided into 2 groups according to the width of QRS; wide QRS (QRS$150msec, wQRS, n579) and narrow QRS (QRS!!, nQRS, n541). LVESV and wall thickness (WT) were evaluated by MIBI scintigraphy before and 6 month after CRT. Difference in WT in the lateral wall to the septum was used as dyssynchrony index (Xwt). Reverse remodeling was defined as more than 10% decrease in LVESV and major adverse cardiac event (MACE) was evaluated by Kaplan-Meyer method after CRT. The prevalence of patients with reverse remodeling was significantly lower in the nQRS than in the wQRS group (42% vs. 77%, P! 0.05) and MACE-rate was significantly higher in the nQRS than in the wQRS group (P!0.05). Xwt before CRT was significantly less in the nQRS than in the wQRS group (7641 vs. 52661, P!0.001). However, MACE-rate in nQRS patients with Xwt$16.5, which was cut-off value of Xwt before CRT obtained by ROC curve, was similar to that in wQRS patients. Conclusions: These results indicate that evaluation of dyssynchrony by MIBI scintigraphy is useful to identify patients with nQRS who could respond to CRT.
P-081 The Long Term Clinical Outcome after Cardiac Resynchronization Therapy in Our Hospital HARUKO WADA, KAZUNORI KASHIWASE, MAYU NISHIO, YASUNORI UEDA Cardiovascular Devision, Osaka Police Hospital
P-078 Impact of Aortic Arch Plaques and Risk of Heart Failure in Patients with Atrial Fibrillation: A Transesophageal Echocardiographic Study NOBUHIDE WATANABE1, SAKI ITO1, KAZUTO YAMAGUCHI2, TOMOKO ADACHI1, NOBUYUKI TAKAHASHI1, HIROYUKI YOSHITOMI2, KAZUAKI TANABE1 1 Cardiology, Shimane University Hospital, 2Clinical Laboratory Department, Shimane University Hospital Background: Atrial fibrillation (AF) and heart failure have emerged as new cardiovascular epidemics. Heart failure with preserved left ventricular ejection fraction, including patients with AF, is recently characterized by systolic-ventricular and arterial stiffening and adverse coupling between the systems. Atherosclerotic aortic plaques $4.0 mm is prognostic predictors of cardiovascular events. The aim of this study was to evaluate impact of large and complex aortic plaques on cardiovascular events, especially heart failure in patients with AF. Methods and Results: 90 patients with AF (mean age: 67611.9 years old) were enrolled. Patients were grouped according to the presence (n536) or absence (n554) of aortic plaques $4.0 mm by transesophageal echocardiography (TEE). Cardiovascular events, including death, myocardial infarction, ischemic stroke, and admission with worsening of congestive heart failure (CHF), were no significant relationships between left ventricular ejection fraction, mitral inflow E/A, tissue doppler E/Ea, left atrial (LA) dense spontaneous echo contrast and LA appendage flow velocities, during a mean follow-up period of 1.9 years. The contribution of risk factors other than age is insignificant. Aortic plaques $4.0 mm by TEE was significantly associated with the worsening of CHF (p50.021). Coclusions: In patients with AF, thick and complex aortic plaques related to arterial stiffness and compliance, may be a significant predictor of the subsequent worsening of CHF. This finding may help therapeutic focus.
Background: In many reports, responders and non-responders were determined by echocardiographic parameters 6 months after cardiac resynchronization therapy (CRT), but there were limited data about the long term clinical outcome after CRT. Methods: We analyzed consecutive 38 patients implanted with a CRT defibrillator between September 2006 and May 2010 in this study. Echocardiography was repeated before and 6 months after implantation. The patients were followed for an average of 1360 (46-2438) days. Results: One patient died within 6 months. Ten patients (26%) were classified as responders (decrease $15% in LVESV), 27 patients (71%) as non-responders (decrease !15% or increase in LVESV). All-cause mortality was 40% in responders (n54) and 46% in non-responders (n513). In responders LVEDV and LVESV before implantation in dead patients were larger than living patients (LVEDV: 319 6 34.2 mL vs. 246 6 35.1 mL, p!0.05, LVESV: 241 6 39.2 mL vs. 160 6 39.3 mL, p!0.05). On the other hand, in non-responders there were no significant differences in LVEDV and LVESV between dead and living patients (LVEDV: 268 6 78.7 mL vs. 248 6 84.6 mL, p5NS, LVESV: 191 6 80.0 mL vs. 170 6 81.0 mL, p5NS). Conclusion: Patients with advanced LV remodeling, even if they are CRT responders, have a poor prognosis. Earlier CRT implantation may prevent LV remodeling and improve outcome.
P-082 Reverse Remodeling after Cardiac Resynchronization Therapy for Idiopathic Dilated Cardiomyopathy: A Case Report TADATSUGU GAMOU, KENJI SAKATA, NOBORU FUJINO, MASAKAZU YAMAGISHI Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine Background: The efficacy of cardiac resynchronization therapy in heart failure with extremely dilated left ventricle has not been fully reported. Case Report: The patient was a 46-year-old man who had developed heart failure. Trans-thoracic echocardiography revealed a severely dilated left ventricle with decreased left ventricular ejection fraction while Tissue Doppler echocardiography showed a significant intraventricular mechanical dyssynchrony. He was diagnosed with idiopathic dilated cardiomyopathy. He failed to recover despite optimal medication included in intravenous inotropic support. After cardiac resynchronization therapy, he was able to be weaned from inotropic support, New York Heart Association class improved from III to I, left ventricular diastolic dimension decreased from 96 to 70 mm, and blood level of brain natriuretic peptide decreased from 514 to 57 pg/ml. Conclusion: Cardiac resynchronization therapy was useful in an idiopathic dilated cardiomyopathy patient with a severely dilated left ventricle.