Evolution of Echocardiography-Derived Hemodynamic Force Parameters After Cardiac Resynchronization Therapy

The American Journal of Cardiology, vol. 209, pp. 138–145

Abstract

Echocardiography-derived hemodynamic forces (HDF) allow calculation of intraventricular pressure gradients from routine transthoracic echocardiographic images. The evolution of HDF after cardiac resynchronization therapy (CRT) has not been investigated in large cohorts. The aim was to assess HDF in patients with heart failure implanted with CRT versus healthy controls. HDF were assessed before and 6 months after CRT. The following HDF parameters were calculated: (1) apical-basal strength, (2) lateral-septal strength, (3) the ratio of lateral-septal to apical-basal strength ratio, and (4) the force vector angle (1 and 2 representing the magnitude of HDF, 3 and 4 representing the orientation of HDF). In the propulsive phase of systole, the apical-basal impulse and the systolic force vector angle were measured. A total of 197 patients were included (age 64 ± 11 years, 62% male), with left ventricular ejection fraction ≤35%, QRS duration ≥130 ms and left bundle branch block. The magnitude of HDF was significantly lower and the orientation was significantly worse in patients with heart failure versus healthy controls. Immediately after CRT implantation, the apical-basal impulse and systolic force vector angle were significantly increased. Six months after CRT, improvement of apical-basal strength, lateral-septal to apical-basal strength ratio and the force vector angle occurred. When CRT was deactivated at 6 months, the increase in the magnitude of apical-basal HDF remained unchanged while the systolic force vector angle worsened significantly. In conclusion, HDF in CRT recipients reflect the acute effect of CRT and the effect of left ventricular reverse remodeling on intraventricular pressure gradients. Whether HDF analysis provides incremental value over established echocardiographic parameters, remains to be determined.

Authors 9

1. Dorien Laenens Aachen Departments of Cardiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

2. Pieter van der Bijl Aachen Departments of Cardiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

3. Xavier Galloo Aachen Departments of Cardiology

   Leiden University · Vrije Universiteit Brussel · Leiden University Medical Center · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Cardiology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium

   Department of Cardiology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

4. Alessandro C. Rossi
   Affiliation as printed

   Ultrasound Department, Medis Medical Imaging, Leiden, The Netherlands

5. Giovanni Tonti

   University of Chieti-Pescara

   Affiliation as printed

   Cardiology Division, G. D'Annunzio University, Chieti, Italy

6. Johan H. C. Reiber Aachen Department of Radiology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Ultrasound Department, Medis Medical Imaging, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

   Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

   Ultrasound Department, Medis Medical Imaging, Leiden, The Netherlands

7. Gianni Pedrizzetti

   University of Trieste · University of California, Irvine

   Affiliation as printed

   Department of Engineering and Architecture, University of Trieste, Trieste, Italy; Department of Biomedical Engineering, University of California, Irvine, California

   Department of Biomedical Engineering, University of California, Irvine, California

   Department of Engineering and Architecture, University of Trieste, Trieste, Italy

8. Nina Ajmone Marsan Aachen Departments of Cardiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

9. Jeroen Joost Bax corresponding Aachen Departments of Cardiology

   Leiden University · University of Turku · Leiden University Medical Center · Turku University Hospital

   Affiliation as printed

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland. Electronic address: j.j.bax@lumc.nl

   Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland

   Departments of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands