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Significant increase of flow kinetic energy in “nonresponders” patients to cardiac resynchronization therapy
Author(s) -
Cimino Sara,
Palombizio Dino,
Cicogna Francesco,
Cantisani Donatella,
Reali Manuela,
Filomena Domenico,
Petronilli Valentina,
Iacoboni Carlo,
Agati Luciano
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13518
Subject(s) - cardiac resynchronization therapy , cardiology , medicine , ejection fraction , heart failure , diastole , concomitant , blood pressure
Backgrounds It's still unclear if different patterns of intraventricular flow dynamics may be detected in patients nonresponders to cardiac resynchronization therapy ( CRT ) as compared to responders ones. Aim of this study was to evaluate the characteristics of left ventricular ( LV ) flow dynamics 6‐months after CRT to identify Echo‐particle imaging velocity ( PIV ) patterns were more frequently detected in nonresponders patients. Methods Thirty‐two patients with dilated cardiomyopathy, undergoing CRT , were enrolled in this study. All patients underwent 2D and 3D echo and fluid dynamics assessment 6 months after CRT , during active CRT ( CRT ‐ ON ) and during a temporarily discontinued state ( CRT ‐ OFF ). LV volumes systolic and diastolic volumes ( LVESV and LVEDV ), ejection fraction ( LVEF ), global longitudinal strain ( GLS ), systolic dyssynchrony index ( SDI ), and several geometrical and functional Echo‐ PIV ‐derived parameters were calculated. Patients were divided in two groups: “responders” to CRT (decrease in LVESV >15% 6 months after CRT ) and “nonresponders.” Results During CRT ‐ OFF , LVEF , GLS were lower, while SDI and LVESV were higher in nonresponders group ( P =.030, P =.051, P =.035, and P =.025, respectively). Energy dissipation, vortex area, and vorticity fluctuation were higher in “nonresponders” patients during CRT ‐ OFF ( P =.038, P =.054, and P =.035, respectively). During CRT ‐ ON , energy dissipation, vortex area, and vorticity fluctuation further increase in nonresponders patients ( P =.020, P =.038, and P =.030, respectively) with a concomitant worsening of SDI ( P =.045). Conclusion Our data show a significant worsening in flow‐derived parameters in CRT “nonresponders” patients as compared with responders. Further larger longitudinal studies are necessary to assess whether these more chaotic intraventricular flow‐patterns may contribute to a persistent adverse remodeling observed in this subset of patients.