Email this article Relationship of septal flash with electromechanical dyssynchrony and super-response to cardiac resynchronization therapy
- Authors: Shirokov N.E.1, Kuznetsov V.A.1, Malishevskii L.M.1, Todosiichuk V.V.1, Soldatova A.M.1, Krinochkin D.V.1
-
Affiliations:
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
- Issue: Vol 5, No 2 (2020)
- Pages: 93-98
- Section: Cardiology
- URL: https://ogarev-online.ru/2500-1388/article/view/43797
- DOI: https://doi.org/10.35693/2500-1388-2020-5-2-93-98
- ID: 43797
Cite item
Full Text
Abstract
Objectives – to identify a relationship of septal flash (SF) with a super-response to cardiac resynchronization therapy (CRT), apical rocking (AR) and signs of left bundle brunch block (LBBB) in patients with congestive heart failure (CHF).
Material and methods. The study included 38 patients (92.1% men; mean age 54.3±9.4 years) with II-IV NYHA functional class CHF. Left bundle brunch block (LBBB) was diagnosed according to 3 criteria: American Heart Association (AHA) 2009, European Society of Cardiology (ESC) 2013, Strauss. Septal flash (SF, mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). The patients were divided into two groups: with SF (I group, n=8) and without SF (II group, n=30). Mean follow-up was 34.5 [13.8;55.3].
Results. At baseline the groups did not differ in main clinical characteristics including QRS. The left ventricular (LV) ejection fraction (EF) was higher in group I (33.1%±1.7 and 30.0%±4.0; p=0.044). Basal segment of IVS longitudinal strain (LS) delay by STE (258.0 [144.0;294.0] ms vs 323.5 [273.3;385.0] ms; р=0.024) and LS delay by TDI (176.0 [146.8;287.3] ms vs 415.5 [315.8;493.5] ms; р<0.001) were significantly lower in group with SF. There was significant relationship between SF signs and Apical rocking (AR) (r=0.791; p=0.034). According to electrocardiogram (ECG) it was found that the q wave in the I and V5, V6 was absent in all patients with SF. Monophasic R wave was in 62.5% in group I and in 16.7% in group II (p=0.019). All patients in group I had a super-response to CRT (ESV LV decrease ≥30%); 53.1% of patients in group II were super responders (р<0.034).
Conclusion. SF is associated with AR, super-response to CRT, and the change of the direction of interventricular septum depolarization vector.
Full Text
##article.viewOnOriginalSite##About the authors
Nikita E. Shirokov
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Author for correspondence.
Email: shirokovne@infarkta.net
ORCID iD: 0000-0002-4325-2633
junior researcher of instrumental diagnostics laboratory, scientific department of instrumental research methods
Russian Federation, TomskVadim A. Kuznetsov
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: shirokovne@infarkta.net
ORCID iD: 0000-0002-1970-2606
PhD, Professor of Cardiology, Scientific consultant
Russian Federation, TomskLev M. Malishevskii
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: shirokovne@infarkta.net
laboratory assistant of instrumental diagnostics laboratory, scientific department of instrumental research methods.
Russian Federation, TomskViktor V. Todosiichuk
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: shirokovne@infarkta.net
ORCID iD: 0000-0003-3601-233X
PhD, Head of functional diagnostics department, lead researcher of instrumental diagnostics laboratory, scientific department of instrumental research methods
Russian Federation, TomskAnna M. Soldatova
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: shirokovne@infarkta.net
ORCID iD: 0000-0001-5389-0973
PhD, research associate of instrumental diagnostics laboratory, scientific department of instrumental research methods
Russian Federation, TomskDmitii V. Krinochkin
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: shirokovne@infarkta.net
ORCID iD: 0000-0003-4993-056X
PhD, Head of ultrasound diagnostics department, senior researcher of instrumental diagnostics laboratory, scientific department of instrumental research methods
Russian Federation, TomskReferences
- Mareev VYu, Fomin IV, Ageev FT, et al. Clinical recommendations SSHF-RSC-RSMST. Heart failure: congestive (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiya. 2018;58(6S):8–158. (In Russ.). [Мареев В.Ю., Фомин И.В., Агеев Ф.Т. и др. Клинические рекомендации ОССН-РКО-РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018; 58(6S): 8–158)]. doi: 10.18087/cardio.2475
- Grant RP, Dodge HT. Mechanisms of QRS complex prolongation in man; left ventricular conduction disturbances. Am J Med. 1956;20:834–52.
- Gjesdal O, Remme EW, Opdahl A, et al. Mechanisms of abnormal systolic motion of the interventricular septum during left bundle-branch block. Circ Cardiovasc Imaging. 2011;4:264–273. doi: 10.1161/circimaging.110.961417
- Risum N, Tayal B, Hansen TF, et al. Identification of typical left bundle branch block contraction by strain echocardiography is additive to electrocardiography in prediction of long-term outcome after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2015;66:631–641. doi: 10.1016/j.jacc.2015.06.020
- Kuznetsov VA, Kolunin GV, Harac VE, et al. Register of Cardiac Resynchronization Therapy. Svidetel'stvo o gosudarstvennoj registracii bazy dannyh №2010620077 ot 1 fevralya 2010 goda. (In Russ.). [Кузнецов В.А., Колунин Г.В., Харац В.Е. и др. «Регистр проведенных операций сердечной ресинхронизирующей терапии». Свидетельство о государственной регистрации базы данных №2010620077 от 1 февраля 2010 года].
- Brignole A, Auricchio G, Baron-Esquivias, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34:2281–2329. doi: 10.1093/europace/eut206
- Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation. 2009;119:e235–40. doi: 10.1161/CIRCULATIONAHA.108.191095
- Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107:927–934. doi: 10.1016/j.amjcard.2010.11.010
- Aranda JMJr, Conti JB, Johnson JW, et al. Cardiac resynchronization therapy in patients with heart failure and conduction abnormalities other than left bundle-branch block: analysis of the Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Clin Cardiol. 2004;27(12):678–82. doi: 10.1002/clc.4960271204
- Gervais R, Leclercq C, Shankar A, et al. CARE-HF investigators. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail. 2009;11(7):699–705. doi: 10.1093/eurjhf/hfp074
- Shiller N, Osipov MA. Clinical Echocardiography. M.: MEDpress-inform, 2018. (In Russ.). [Шиллер Н., Осипов М.А. Клиническая эхокардиография. М.: МЕДпресс-информ, 2018].
- Risum N. Assessment of mechanical dyssynchrony in cardiac resynchronization therapy. Dan Med J. 2014; 61(12):B4981.
- Ghani A, Delnoy PPH, Smit JJJ, et al. Association of apical rocking with super-response to cardiac resynchronisation therapy. Netherlands Heart Journal. 2016;24(1):39–46. doi: 10.1007/s12471-015-0768-4
- Auricchio A, Fantoni C, Regoli F, et al. Characterization of left ventricular activation in patients with heart failure and left bundle branch block. Circulation. 2004;109:1133–9. doi: 10.1161/01.CIR.0000118502.91105.F6
- Ghani A, Delnoy PPH, Ottervanger JP, et al. Association of apical rocking with long-term major adverse cardiac events in patients undergoing cardiac resynchronization therapy. European Heart Journal – Cardiovascular Imaging. 2015;17(2):146–153. doi: 10.1093/ehjci/jev236
- Kanzaki H, Bazaz R, Schwartzman D, et al. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. Journal of the American College of Cardiology. 2004;44(8):1619–1625. doi: 10.1016/j.jacc.2004.07.036
- Doltra A, et al. Mechanical abnormalities detected with conventional echocardiography are associated with response and midterm survival in CRT. JACC: Cardiovascular Imaging. 2014;7(10):969–979. doi: http://dx.doi.org/10.1016/j.jcmg.2014.03.022
- Kuznetsov VA. Cardiac resynchronization therapy: selected questions. M.: Abis, 2007. (In Russ.). [Кузнецов В.А. Сердечная ресинхронизирующая терапия: избранные вопросы. М.: Абис, 2007].
Supplementary files
