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Tagged cardiovascular magnetic resonance (CMR) is a noninvasive technique for measuring local deformation of the myocardium and quantitative assessment of mechanical dyssynchrony.
LBBB VS IVCD TRIAL
While mechanical dyssynchrony assessed in the longitudinal axis of myocardial motion was shown to be predicative in single center trials, the multi-center PROSPECT trial failed to identify any echocardiographic dyssynchrony criteria to predict responders better than the clinical criteria. As a result, there has been intense investigation to develop noninvasive parameters to predict CRT response. However, 30-40% of patients who receive CRT therapy do not show significant clinical improvement. Recent data from patients with NYHA class I/II HF also demonstrated reduced HF hospitalization and reversal of left ventricular (LV) remodeling with CRT therapy. Myocardial circumferential strain analysis enables detailed characterization of contraction patterns, strengths, and timing in cardiomyopathy patients with and without LBBB.Ĭardiac resynchronization therapy (CRT) has been shown to improve symptoms, increase exercise capacity, decrease heart failure (HF) hospitalizations, and decrease mortality in patients with New York Heart Association (NYHA) Class III/IV HF with depressed systolic function, and a prolonged QRS in left bundle branch block (LBBB) morphology. Septal dyskinesis exists in some patients with LBBB. The LBBB group had significantly greater dyssynchrony compared to the non-LBBB group and healthy controls assessed by opposing wall delays and 12-segment standard deviation (LBBB 164 ± 30 ms vs. healthy 19 ± 4% both p < 0.0001 compared to healthy), but was similar among the LBBB and non-LBBB groups (p = 0.20). Peak circumferential strain shortening was significantly reduced in all cardiomyopathy patients at the mid-ventricular level (LBBB 9 ± 6%, non-LBBB 10 ± 4% vs. Resultsĭyskinesis of the anterior septum and the inferior septum in at least two ventricular levels was seen in 50% (5 out of 10) of LBBB patients while 30% had isolated dyskinesis of the anteroseptum, and 20% had no dyskinesis in any segments, similar to all of the non-LBBB patients and healthy controls. Time to peak systolic circumferential strain in each of the 6 segments in all three ventricular slices and the standard deviation of time to peak strain in the basal and mid ventricular slices were determined. Patterns of circumferential strain were analyzed.
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We determined myocardial circumferential strain at the basal, mid, and apical ventricular level in 35 subjects (10 with ischemic cardiomyopathy, 15 with non-ischemic cardiomyopathy, and 10 healthy controls). We hypothesized that different left ventricular contraction patterns may exist in LBBB patients with depressed systolic function and applied tagged cardiovascular magnetic resonance (CMR) to assess circumferential strain in this population. There have been intense efforts to find reproducible non-invasive parameters to predict CRT response. The ECG in Acute MI.Cardiac resynchronization therapy (CRT) has been shown to decrease mortality in 60-70% of advanced heart failure patients with left bundle branch block (LBBB) and QRS duration > 120 ms. ECG in Emergency Medicine and Acute Care 1e, 2004 ECG’s for the Emergency Physician Part I 1e, 2003 and Part II Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
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Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009
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Marriott’s Practical Electrocardiography 13e, 2021 Electrocardiography in Emergency, Acute, and Critical Care. ECG Blue Belt online course: Learn to diagnose any rhythm problem. ECG Yellow Belt online course : Become an ECG expert.