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Myocardial motion and deformation patterns in an experimental swine model of acute LBBB/CRT and chronic infarct

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Abstract

In cardiac resynchronization therapy (CRT), specific changes in motion/deformation happen with left-bundle-branch-block (LBBB) and following treatment. However, they remain sub-optimally studied. We propose a two-fold improvement of their characterization. This includes controlling them through an experimental model and using more suitable quantification techniques. We used a swine model of acute LBBB and CRT with/without chronic infarct (pure-LBBB: N = 11; LBBB + left-anterior-descending infarct: N = 11). Myocardial displacement, velocity and strain were extracted from short-axis echocardiographic sequences using 2D speckle-tracking. The data was transformed to a single spatiotemporal system of coordinates to perform subject comparisons and quantify pattern changes at similar locations and instants. Pure-LBBB animals showed a specific intra-ventricular dyssynchrony pattern with LBBB (11/11 animals), and the recovery towards a normal pattern with CRT (10/11 animals). Pattern variability was low within the pure-LBBB population, as quantified by our method. This was not correctly assessed by more conventional measurements. Infarct presence affected the pattern distribution and CRT efficiency (improvements in 6/11 animals). Pattern changes correlated with global cardiac function (global circumferential strain) changes in all the animals (corrected: pLBBBvsBaseline < 0.001, pCRTvsBaseline = NS; non-corrected: pLBBBvsBaseline = NS, pCRTvsBaseline = 0.028). Our LBBB/CRT experimental model allowed controlling specific factors responsible for changes in mechanical dyssynchrony and therapy. We illustrated the importance of our quantification method to study these changes and their variability. Our findings confirm the importance of myocardial viability and of specific LBBB-related mechanical dyssynchrony patterns.

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Notes

  1. Strain is a spatially differential measure and is not affected by this correction.

  2. The temporal alignment required the identification of 6 events per cycle. The onset of QRS (beginning and ending of the cycle) was identified on the ECG. Valve events (aortic/mitral valve opening/closure [AVO/AVC/MVO/MVC]) were identified using continuous-wave Doppler imaging on the corresponding valve, when possible, or visually on short-axis 2D views.

  3. http://nicolasduchateau.wordpress.com/downloads/.

  4. NS: Non-significant statistical difference (p value > 0.05).

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Acknowledgments

This work was partially supported by the Centre for the Development of Industrial Technology, Madrid, Spain (cvREMOD CEN-20091044) and the European Union Seventh Framework Programme (VP2HF FP7-2013-611823). AD had a post-residency grant from Fundació Clínic, Barcelona, Spain. The authors acknowledge David Andreu and Santiago Sotes (Hospital Clínic, Barcelona, Spain), Daniel Traver (Biosense Webster, Barcelona, Spain), Laia Bayarri and Filippo Ziglio (Sorin Group, Barcelona/Milan, Spain/Italy) for their support on the experimental devices.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Arrythmia, Resynchronization and Cardiac Imaging Unit, Hospital Clínic, Universitat de Barcelona, Calle Villaroel 170, 08036, Barcelona, Spain

    Nicolas Duchateau, Marta Sitges, Adelina Doltra, Juan Fernández-Armenta, Nuria Solanes, Montserrat Rigol, Luigi Gabrielli, Etelvino Silva, Antonio Berruezo, Lluís Mont & Josep Brugada

  2. Institut d’investigacions Biomèdiques August Pi i Sunyer, c/Rosselló 149-153, 08036, Barcelona, Spain

    Nicolas Duchateau, Marta Sitges, Adelina Doltra, Juan Fernández-Armenta, Nuria Solanes, Montserrat Rigol, Luigi Gabrielli, Etelvino Silva, Antonio Berruezo, Lluís Mont & Josep Brugada

  3. División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Marcoleta 367, 22354 3000, Santiago, Chile

    Luigi Gabrielli

  4. Sorin Group, Av/de les Corts Catalanes 8, Sant Cugat del Vallès, 08173, Barcelona, Spain

    Aina Barceló

  5. Universitat Pompeu Fabra, c/Roc Boronat 138, 08018, Barcelona, Spain

    Nicolas Duchateau & Bart Bijnens

  6. ICREA, Pg/Lluís Companys 23, 08010, Barcelona, Spain

    Bart Bijnens

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  1. Nicolas Duchateau
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Correspondence to Nicolas Duchateau.

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Josep Brugada and Bart Bijnens share senior authorship.

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Duchateau, N., Sitges, M., Doltra, A. et al. Myocardial motion and deformation patterns in an experimental swine model of acute LBBB/CRT and chronic infarct. Int J Cardiovasc Imaging 30, 875–887 (2014). https://doi.org/10.1007/s10554-014-0403-2

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