- Structural and Physiological Imaging to Predict the Risk of Lethal Ventricular Arrhythmias and Sudden Death. [Review]JACC Cardiovasc Imaging 2019; 12(10):2049-2064JC
- Identifying patients at risk of sudden cardiac death remains a major challenge in cardiovascular medicine. Advances in cardiovascular imaging have identified several anatomic and functional variables that can be quantified as continuous variables to predict the risk of developing lethal ventricular tachyarrhythmias in patients with depressed left ventricular (LV) systolic function. Some, such as …
Identifying patients at risk of sudden cardiac death remains a major challenge in cardiovascular medicine. Advances in cardiovascular imaging have identified several anatomic and functional variables that can be quantified as continuous variables to predict the risk of developing lethal ventricular tachyarrhythmias in patients with depressed left ventricular (LV) systolic function. Some, such as LV mass, volume, and the dyssynchrony of contraction, can be derived from currently available echocardiographic and nuclear imaging modalities. Others require advanced cardiac imaging modalities with quantification of myocardial scar with gadolinium-enhanced cardiac magnetic resonance and myocardial sympathetic denervation using norepinephrine analogs and positron emission tomography or single-photon emission computed tomography offering the most promise. There is an immediate need to develop a sequential cost-effective approach that capitalizes on readily available clinical information complemented with advanced imaging modalities in selected patients to improve risk stratification for arrhythmic death beyond LV ejection fraction.
- Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: a feasibility study in left bundle branch block. [Journal Article]Eur Heart J Cardiovasc Imaging 2019EH
- CONCLUSIONS: FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.
- Impact of left bundle branch block on myocardial perfusion and metabolism: A positron emission tomography study. [Journal Article]J Nucl Cardiol 2019JN
- CONCLUSIONS: Non-ischemic CRT candidates with LBBB demonstrate lower glucose uptake and absolute MBF in the septum compared to the lateral wall. However, late static 13N-NH3 uptake showed a homogenous distribution, reflecting a composite measure of altered regional MBF and metabolism, induced by LBBB.
- Tissue Doppler-derived atrial dyssynchrony predicts new-onset atrial fibrillation during hospitalization for ST-elevation myocardial infarction. [Journal Article]Echocardiography 2019E
- CONCLUSIONS: In the acute phase after STEMI, history of hypertension, LAVImax, and inter-atrial dyssynchrony were independent determinants of inhospital NOAF, with the latter being the strongest.
- Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction. [Journal Article]Echocardiography 2019E
- CONCLUSIONS: LV systolic function and mechanical dyssynchrony were impaired in HFpEF patients. Deteriorated LV longitudinal systolic function was likely correlated with the symptoms of HFpEF.
- The evaluation of left ventricular dyssynchrony in hypertensive patients with a preserved systolic function undergoing gated SPECT myocardial perfusion imaging. [Journal Article]Ann Nucl Med 2019AN
- CONCLUSIONS: Our study findings are in favor of using phase analysis-gated SPECT imaging as a routine way for detection of LVD-known indicator of progression toward systolic dysfunction in the future-in hypertensive patients with a low risk for coronary artery diseases and a normal cardiac systolic function.
- Quantitative Assessment of Left Ventricular Dysfunction in Fetal Ebstein's Anomaly and Tricuspid Valve Dysplasia. [Journal Article]J Am Soc Echocardiogr 2019JA
- CONCLUSIONS: Fetal EA/TVD is associated with a lack of spherical remodeling and presence of mechanical dyssynchrony, which likely contribute to reduced CO and ejection fraction. Clinical monitoring of LV function is warranted in fetal EA/TVD. Further studies incorporating quantification of LV function into prediction models for adverse outcomes are required.
- Comparison of three-dimensional echocardiography and speckle tracking echocardiography in quantification and mapping of intraventricular mechanical dyssynchrony. [Journal Article]Indian Heart J 2019 May - Jun; 71(3):256-262IH
- CONCLUSIONS: Both 3DE and STE provided consistent results with progressive rise in magnitude of LVMD, correlating with disease severity. 3DE diagnosed more patients as having LVMD in those having LV dysfunction with narrow QRS. The most delayed segment assessed by two methods matched only in about half the cases. Correlation with clinical CRT responsiveness is needed to conclude which method is more accurate in dyssynchrony mapping for targeted lead placement.
- Non-invasively quantified changes in left ventricular activation predict outcomes in patients undergoing cardiac resynchronization therapy. [Journal Article]J Cardiovasc Electrophysiol 2019JC
- CONCLUSIONS: CRT induced ΔQRSA was associated with clinically meaningful changes in event-free survival. ΔQRSA may be a novel target to guide lead implantation and device optimization.
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- Localized basal left ventricular dyssynchrony induced by manifest accessory pathway: Successful differentiation from cardiac involvement of sarcoidosis with administration of flecainide acetate. [Journal Article]J Electrocardiol 2019; 57:87-89JE
- We present a patient with non-cardiac sarcoidosis complicated with manifest ventricular preexcitation. Initially, cardiac involvement of sarcoidosis was suspected from the echocardiographic findings showing localized hypokinesia at the left ventricular basal inferior wall. We, however, considered that the hypokinesia was a preexcitation-induced mechanical dyssynchrony rather than cardiac sarcoido…
We present a patient with non-cardiac sarcoidosis complicated with manifest ventricular preexcitation. Initially, cardiac involvement of sarcoidosis was suspected from the echocardiographic findings showing localized hypokinesia at the left ventricular basal inferior wall. We, however, considered that the hypokinesia was a preexcitation-induced mechanical dyssynchrony rather than cardiac sarcoidosis, because polarities of the delta-waves indicated a left ventricular inferior accessory pathway. Temporal administration of oral flecainide acetate eliminated the basal left ventricular motion abnormality. Accordingly, we could successfully differentiate the mechanism of hypokinesia. In this context, we could rule out cardiac sarcoidosis, and initiation of glucocorticoid therapy was reasonably withheld.