Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist

Matteo Bertini, Nina Ajmone Marsan, Victoria Delgado, Rutger J. van Bommel, Gaetano Nucifora, C. Jan Willem Borleffs, Giuseppe Boriani, Mauro Biffi, Eduard R. Holman, Ernst E. van der Wall, Martin J. Schalij, Jeroen J. Bax

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15% at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.

LanguageEnglish
Pages1317-1325
Number of pages9
JournalJournal of the American College of Cardiology
Volume54
Issue number14
DOIs
Publication statusPublished - 29 Sep 2009

Keywords

  • cardiac resynchronization therapy
  • heart failure
  • left ventricular lead position
  • left ventricular reverse remodeling
  • left ventricular twist

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bertini, M., Marsan, N. A., Delgado, V., van Bommel, R. J., Nucifora, G., Borleffs, C. J. W., ... Bax, J. J. (2009). Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist. Journal of the American College of Cardiology, 54(14), 1317-1325. https://doi.org/10.1016/j.jacc.2009.05.063
Bertini, Matteo ; Marsan, Nina Ajmone ; Delgado, Victoria ; van Bommel, Rutger J. ; Nucifora, Gaetano ; Borleffs, C. Jan Willem ; Boriani, Giuseppe ; Biffi, Mauro ; Holman, Eduard R. ; van der Wall, Ernst E. ; Schalij, Martin J. ; Bax, Jeroen J. / Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist. In: Journal of the American College of Cardiology. 2009 ; Vol. 54, No. 14. pp. 1317-1325.
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abstract = "Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15{\%} at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56{\%}), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95{\%} confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7{\%} to 37 ± 7{\%}, p < 0.001) and midventricular (from 26 ± 6{\%} to 33 ± 8{\%}, p < 0.001) but not with a basal (26 ± 5{\%} vs. 28 ± 8{\%}, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.",
keywords = "cardiac resynchronization therapy, heart failure, left ventricular lead position, left ventricular reverse remodeling, left ventricular twist",
author = "Matteo Bertini and Marsan, {Nina Ajmone} and Victoria Delgado and {van Bommel}, {Rutger J.} and Gaetano Nucifora and Borleffs, {C. Jan Willem} and Giuseppe Boriani and Mauro Biffi and Holman, {Eduard R.} and {van der Wall}, {Ernst E.} and Schalij, {Martin J.} and Bax, {Jeroen J.}",
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Bertini, M, Marsan, NA, Delgado, V, van Bommel, RJ, Nucifora, G, Borleffs, CJW, Boriani, G, Biffi, M, Holman, ER, van der Wall, EE, Schalij, MJ & Bax, JJ 2009, 'Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist', Journal of the American College of Cardiology, vol. 54, no. 14, pp. 1317-1325. https://doi.org/10.1016/j.jacc.2009.05.063

Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist. / Bertini, Matteo; Marsan, Nina Ajmone; Delgado, Victoria; van Bommel, Rutger J.; Nucifora, Gaetano; Borleffs, C. Jan Willem; Boriani, Giuseppe; Biffi, Mauro; Holman, Eduard R.; van der Wall, Ernst E.; Schalij, Martin J.; Bax, Jeroen J.

In: Journal of the American College of Cardiology, Vol. 54, No. 14, 29.09.2009, p. 1317-1325.

Research output: Contribution to journalArticle

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T1 - Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist

AU - Bertini, Matteo

AU - Marsan, Nina Ajmone

AU - Delgado, Victoria

AU - van Bommel, Rutger J.

AU - Nucifora, Gaetano

AU - Borleffs, C. Jan Willem

AU - Boriani, Giuseppe

AU - Biffi, Mauro

AU - Holman, Eduard R.

AU - van der Wall, Ernst E.

AU - Schalij, Martin J.

AU - Bax, Jeroen J.

PY - 2009/9/29

Y1 - 2009/9/29

N2 - Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15% at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.

AB - Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position. Background: LV twist is emerging as a comprehensive index of LV function. Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume ≥15% at 6-month follow-up. A control group comprised 30 normal subjects. Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position. Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.

KW - cardiac resynchronization therapy

KW - heart failure

KW - left ventricular lead position

KW - left ventricular reverse remodeling

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Bertini M, Marsan NA, Delgado V, van Bommel RJ, Nucifora G, Borleffs CJW et al. Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist. Journal of the American College of Cardiology. 2009 Sep 29;54(14):1317-1325. https://doi.org/10.1016/j.jacc.2009.05.063