Association between echocardiography-derived haemodynamic force parameters and left ventricular reverse remodelling after cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging, vol. 25, pp. 1721–1733

Abstract

AIMS: Cardiac resynchronization therapy (CRT) may induce left ventricular (LV) reverse remodelling (=LV response) in patients with heart failure. Intraventricular pressure gradients can be quantified using echocardiography-derived haemodynamic forces (HDF). The aim was to evaluate the association between baseline HDF and LV response and to compare the change of HDF after CRT between LV responders and LV non-responders. METHODS AND RESULTS: The following HDF parameters were assessed: (i) apical-basal (AB) strength, (ii) lateral-septal strength, (iii) force vector angle, (iv) systolic AB impulse, (v) systolic force vector angle. LV response was defined as a reduction of LV end-systolic volume ≥ 15% at six months. One hundred ninety-six patients were included [64 ± 11 years, 122 (62%) men], 136 (69%) showed LV response. On multivariable logistic regression analysis, the force vector angle in the complete heart cycle [OR 1.083 (95% CI: 1.018, 1.153), P = 0.012] and the systolic force vector angle [OR 1.089 (95% CI: 1.021, 1.161), P = 0.009], both included in separate models, were independently associated with LV response. Six months after CRT, LV responders had greater AB strength, AB impulse, and higher force vector angles, while LV non-responders only showed improvement in the force vector angle in the complete heart cycle. CONCLUSION: The orientation of HDF at baseline is associated with LV response to CRT. Six months after CRT, the orientation of HDF improves in LV responders and LV non-responders, while the magnitude of AB HDF only improves in LV responders.

Authors 8

1. Dorien Laenens Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

2. Pieter van der Bijl Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

3. Xavier Galloo Aachen Department of Cardiology, Leiden University Medical Centre

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

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Department of Cardiology, University Hospital Brussels, Vrije Universiteit Brussel , Laarbeeklaan 101, 1090 Brussels ,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

   Department of Cardiology, University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium

4. Giovanni Tonti

   University of Chieti-Pescara

   Affiliation as printed

   Cardiology Division, G. D’Annunzio University , Chieti ,

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

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

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Medis Medical Imaging , Schuttersveld 9, 2316 XG Leiden ,

   Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

   Medis Medical Imaging, Schuttersveld 9, 2316 XG Leiden, The Netherlands

6. Gianni Pedrizzetti

   University of Trieste · University of California, Irvine

   Affiliation as printed

   Department of Biomedical Engineering, University of California , 402 E Peltason Dr, Irvine, CA 92617 ,

   Department of Engineering and Architecture, University of Trieste , Via Alfonso Valerio, 6/1, 34127 Trieste TS ,

   Department of Biomedical Engineering, University of California, 402 E Peltason Dr, Irvine, CA 92617, USA

   Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio, 6/1, 34127 Trieste TS, Italy

7. Nina Ajmone Marsan Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

8. Jeroen Joost Bax corresponding Aachen Department of Cardiology, Leiden University Medical Centre

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

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2, 2333 ZA Leiden ,

   Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital , Kiinamyllynkatu 4-8, 20521 Turku ,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

   Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland