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Physiological relevance of quantifying segmental contraction synchrony

Kim, HK and Tanabe, M and Gorcsan, J and Schwartzman, D and Shroff, SG and Pinsky, MR (2012) Physiological relevance of quantifying segmental contraction synchrony. PACE - Pacing and Clinical Electrophysiology, 35 (2). 174 - 187. ISSN 0147-8389

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Abstract

Background: Most current indices of synchrony quantify left ventricular (LV) contraction pattern in terms of a single, global (integrated) measure. We report the development and physiological relevance of a novel method to quantify LV segmental contraction synchrony. Methods: LV pressure-volume and echocardiographic data were collected in seven anesthetized, opened-chest dogs under several pacing modes: right atrial (RA) (control), right ventricular (RV) (dyssynchrony), and additional LV pacing at either apex (CRTa) or free wall (CRTf). Cross-correlation-based integrated (CCSIint) and segmental (CCSIseg) measures of synchrony were calculated from speckle-tracking derived radial strain, along with a commonly used index (maximum time delay). LV contractility was quantified using either Ees(ESPVR slope) or ESPVRarea(defined in the manuscript). Results: RV pacing decreased CCSIintat LV base (0.95 ± 0.02 [RA] vs 0.64 ± 0.14 [RV]; P < 0.05) and only CRTa improved it (0.93 ± 0.03; P < 0.05 vs RV). The CCSIseganalysis identified anteroseptal and septal segments as being responsible for the low CCSIintduring RV pacing and inferior segment for poor resynchronization with CRTf. Changes in ESPVRarea, and not in Ees, indicated depressed LV contractility with RV pacing, an observation consistent with significantly decreased global LV performance (stroke work [SW]: 252 ± 23 [RA] vs 151 ± 24 [RV] mJ; P < 0.05). Only CRTa improved SW and contractility (SW: 240 ± 19 mJ; ESPVRarea: 545 ± 175 mmHg•mL; both P < 0.01 vs RV). Only changes in CCSIsegand global LV contractility were strongly correlated (R2= 0.698, P = 0.005). Conclusion: CCSIsegprovided insights into the changes in LV integrated contraction pattern and a better link to global LV contractility changes. © 2012 Wiley Periodicals, Inc.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kim, HKhyk11@pitt.eduHYK11
Tanabe, M
Gorcsan, Jgorcsan@pitt.eduGORCSAN
Schwartzman, D
Shroff, SGsshroff@pitt.eduSSHROFF
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 February 2012
Date Type: Publication
Journal or Publication Title: PACE - Pacing and Clinical Electrophysiology
Volume: 35
Number: 2
Page Range: 174 - 187
DOI or Unique Handle: 10.1111/j.1540-8159.2011.03246.x
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0147-8389
PubMed ID: 22017611
Date Deposited: 07 Mar 2012 20:57
Last Modified: 10 Jan 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/11378

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