Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy

Hsin Yueh Liang, Alan Cheng, Kuan Cheng Chang, Ronald D. Berger, Kunal Agarwal, Patrick Eulitt, Mary Corretti, Gordon F. Tomaselli, Hugh Calkins, David A. Kass, Theodore P. Abraham

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: The aim of this study was to evaluate atrial and ventricular function in patients undergoing cardiac resynchronization therapy (CRT). Background: Right atrial pacing (AP) in CRT induces delays in electrical and mechanical activation of the left atrium. The influence of atrial sensing (AS) versus AP on ventricular performance in CRT and the mechanisms underlying the differences between AS and AP in CRT have not been fully elucidated. Methods: Fifty-five patients with heart failure undergoing CRT for 9 ± 12.5 months and 22 control subjects without heart failure were enrolled. Conventional and tissue Doppler echocardiography was performed to examine atrial and ventricular mechanics and hemodynamic status. Results: The optimal atrioventricular interval was shorter in AS compared with AP mode (126 ± 19 ms vs. 155 ± 20 ms, p < 0.0001). Left ventricular (LV) outflow tract time-velocity integral (22 ± 7 cm vs. 20 ± 7 cm, p < 0.001), diastolic filling period (468 ± 124 ms vs. 380 ± 93 ms, p < 0.001), and global strain (-32 ± 24% vs. -27 ± 22%, p = 0.001) were greater in AS compared with AP mode. Atrial strain was higher in AS compared with AP mode in the right atrium (-28.2 ± 8.6% vs. -22.6 ± 7.6%, p = 0.0007), interatrial septum (-17.1 ± 6.5% vs. -13.2 ± 5.4%, p = 0.002), and left atrium (-16.4 ± 11.0% vs. -13.6 ± 8.5%, p = 0.02). There was no difference in intraventricular dyssynchrony but significantly lower atrial dyssynchrony in AS compared with AP mode (31 ± 19 ms vs. 42 ± 24 ms, p = 0.0002). Conclusions: AS is associated with preserved atrial contractility and atrial synchrony, resulting in optimal LV diastolic filling, stroke volume, and LV systolic mechanics. This pacing mode maximizes LV performance and the hemodynamic benefit of CRT in patients with heart failure.

Original languageEnglish (US)
Pages (from-to)691-698
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume4
Issue number7
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

Fingerprint

Atrial Function
Cardiac Resynchronization Therapy
Heart Failure
Hemodynamics
Heart Atria
Mechanics
Therapeutics
Ventricular Function
Doppler Echocardiography
Stroke Volume

Keywords

  • atrial function
  • cardiac resynchronization therapy
  • strain echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy. / Liang, Hsin Yueh; Cheng, Alan; Chang, Kuan Cheng; Berger, Ronald D.; Agarwal, Kunal; Eulitt, Patrick; Corretti, Mary; Tomaselli, Gordon F.; Calkins, Hugh; Kass, David A.; Abraham, Theodore P.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 7, 01.07.2011, p. 691-698.

Research output: Contribution to journalArticle

Liang, HY, Cheng, A, Chang, KC, Berger, RD, Agarwal, K, Eulitt, P, Corretti, M, Tomaselli, GF, Calkins, H, Kass, DA & Abraham, TP 2011, 'Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy', JACC: Cardiovascular Imaging, vol. 4, no. 7, pp. 691-698. https://doi.org/10.1016/j.jcmg.2011.02.019
Liang, Hsin Yueh ; Cheng, Alan ; Chang, Kuan Cheng ; Berger, Ronald D. ; Agarwal, Kunal ; Eulitt, Patrick ; Corretti, Mary ; Tomaselli, Gordon F. ; Calkins, Hugh ; Kass, David A. ; Abraham, Theodore P. / Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy. In: JACC: Cardiovascular Imaging. 2011 ; Vol. 4, No. 7. pp. 691-698.
@article{c8d3a79945f24a539aa02e38331bd937,
title = "Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy",
abstract = "Objectives: The aim of this study was to evaluate atrial and ventricular function in patients undergoing cardiac resynchronization therapy (CRT). Background: Right atrial pacing (AP) in CRT induces delays in electrical and mechanical activation of the left atrium. The influence of atrial sensing (AS) versus AP on ventricular performance in CRT and the mechanisms underlying the differences between AS and AP in CRT have not been fully elucidated. Methods: Fifty-five patients with heart failure undergoing CRT for 9 ± 12.5 months and 22 control subjects without heart failure were enrolled. Conventional and tissue Doppler echocardiography was performed to examine atrial and ventricular mechanics and hemodynamic status. Results: The optimal atrioventricular interval was shorter in AS compared with AP mode (126 ± 19 ms vs. 155 ± 20 ms, p < 0.0001). Left ventricular (LV) outflow tract time-velocity integral (22 ± 7 cm vs. 20 ± 7 cm, p < 0.001), diastolic filling period (468 ± 124 ms vs. 380 ± 93 ms, p < 0.001), and global strain (-32 ± 24{\%} vs. -27 ± 22{\%}, p = 0.001) were greater in AS compared with AP mode. Atrial strain was higher in AS compared with AP mode in the right atrium (-28.2 ± 8.6{\%} vs. -22.6 ± 7.6{\%}, p = 0.0007), interatrial septum (-17.1 ± 6.5{\%} vs. -13.2 ± 5.4{\%}, p = 0.002), and left atrium (-16.4 ± 11.0{\%} vs. -13.6 ± 8.5{\%}, p = 0.02). There was no difference in intraventricular dyssynchrony but significantly lower atrial dyssynchrony in AS compared with AP mode (31 ± 19 ms vs. 42 ± 24 ms, p = 0.0002). Conclusions: AS is associated with preserved atrial contractility and atrial synchrony, resulting in optimal LV diastolic filling, stroke volume, and LV systolic mechanics. This pacing mode maximizes LV performance and the hemodynamic benefit of CRT in patients with heart failure.",
keywords = "atrial function, cardiac resynchronization therapy, strain echocardiography",
author = "Liang, {Hsin Yueh} and Alan Cheng and Chang, {Kuan Cheng} and Berger, {Ronald D.} and Kunal Agarwal and Patrick Eulitt and Mary Corretti and Tomaselli, {Gordon F.} and Hugh Calkins and Kass, {David A.} and Abraham, {Theodore P.}",
year = "2011",
month = "7",
day = "1",
doi = "10.1016/j.jcmg.2011.02.019",
language = "English (US)",
volume = "4",
pages = "691--698",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Influence of atrial function and mechanical synchrony on LV hemodynamic status in heart failure patients on resynchronization therapy

AU - Liang, Hsin Yueh

AU - Cheng, Alan

AU - Chang, Kuan Cheng

AU - Berger, Ronald D.

AU - Agarwal, Kunal

AU - Eulitt, Patrick

AU - Corretti, Mary

AU - Tomaselli, Gordon F.

AU - Calkins, Hugh

AU - Kass, David A.

AU - Abraham, Theodore P.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - Objectives: The aim of this study was to evaluate atrial and ventricular function in patients undergoing cardiac resynchronization therapy (CRT). Background: Right atrial pacing (AP) in CRT induces delays in electrical and mechanical activation of the left atrium. The influence of atrial sensing (AS) versus AP on ventricular performance in CRT and the mechanisms underlying the differences between AS and AP in CRT have not been fully elucidated. Methods: Fifty-five patients with heart failure undergoing CRT for 9 ± 12.5 months and 22 control subjects without heart failure were enrolled. Conventional and tissue Doppler echocardiography was performed to examine atrial and ventricular mechanics and hemodynamic status. Results: The optimal atrioventricular interval was shorter in AS compared with AP mode (126 ± 19 ms vs. 155 ± 20 ms, p < 0.0001). Left ventricular (LV) outflow tract time-velocity integral (22 ± 7 cm vs. 20 ± 7 cm, p < 0.001), diastolic filling period (468 ± 124 ms vs. 380 ± 93 ms, p < 0.001), and global strain (-32 ± 24% vs. -27 ± 22%, p = 0.001) were greater in AS compared with AP mode. Atrial strain was higher in AS compared with AP mode in the right atrium (-28.2 ± 8.6% vs. -22.6 ± 7.6%, p = 0.0007), interatrial septum (-17.1 ± 6.5% vs. -13.2 ± 5.4%, p = 0.002), and left atrium (-16.4 ± 11.0% vs. -13.6 ± 8.5%, p = 0.02). There was no difference in intraventricular dyssynchrony but significantly lower atrial dyssynchrony in AS compared with AP mode (31 ± 19 ms vs. 42 ± 24 ms, p = 0.0002). Conclusions: AS is associated with preserved atrial contractility and atrial synchrony, resulting in optimal LV diastolic filling, stroke volume, and LV systolic mechanics. This pacing mode maximizes LV performance and the hemodynamic benefit of CRT in patients with heart failure.

AB - Objectives: The aim of this study was to evaluate atrial and ventricular function in patients undergoing cardiac resynchronization therapy (CRT). Background: Right atrial pacing (AP) in CRT induces delays in electrical and mechanical activation of the left atrium. The influence of atrial sensing (AS) versus AP on ventricular performance in CRT and the mechanisms underlying the differences between AS and AP in CRT have not been fully elucidated. Methods: Fifty-five patients with heart failure undergoing CRT for 9 ± 12.5 months and 22 control subjects without heart failure were enrolled. Conventional and tissue Doppler echocardiography was performed to examine atrial and ventricular mechanics and hemodynamic status. Results: The optimal atrioventricular interval was shorter in AS compared with AP mode (126 ± 19 ms vs. 155 ± 20 ms, p < 0.0001). Left ventricular (LV) outflow tract time-velocity integral (22 ± 7 cm vs. 20 ± 7 cm, p < 0.001), diastolic filling period (468 ± 124 ms vs. 380 ± 93 ms, p < 0.001), and global strain (-32 ± 24% vs. -27 ± 22%, p = 0.001) were greater in AS compared with AP mode. Atrial strain was higher in AS compared with AP mode in the right atrium (-28.2 ± 8.6% vs. -22.6 ± 7.6%, p = 0.0007), interatrial septum (-17.1 ± 6.5% vs. -13.2 ± 5.4%, p = 0.002), and left atrium (-16.4 ± 11.0% vs. -13.6 ± 8.5%, p = 0.02). There was no difference in intraventricular dyssynchrony but significantly lower atrial dyssynchrony in AS compared with AP mode (31 ± 19 ms vs. 42 ± 24 ms, p = 0.0002). Conclusions: AS is associated with preserved atrial contractility and atrial synchrony, resulting in optimal LV diastolic filling, stroke volume, and LV systolic mechanics. This pacing mode maximizes LV performance and the hemodynamic benefit of CRT in patients with heart failure.

KW - atrial function

KW - cardiac resynchronization therapy

KW - strain echocardiography

UR - http://www.scopus.com/inward/record.url?scp=79960291585&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960291585&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2011.02.019

DO - 10.1016/j.jcmg.2011.02.019

M3 - Article

VL - 4

SP - 691

EP - 698

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 7

ER -