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dc.contributor.authorAalen, John
dc.contributor.authorDonal, Erwan
dc.contributor.authorLarsen, Camilla Kjellstad
dc.contributor.authorDuchenne, Jürgen
dc.contributor.authorLederlin, Mathieu
dc.contributor.authorCvijic, Marta
dc.contributor.authorHubert, Arnaud
dc.contributor.authorVoros, Gabor
dc.contributor.authorLeclercq, Christophe
dc.contributor.authorBogaert, Jan
dc.contributor.authorHopp, Einar
dc.contributor.authorFjeld, Jan Gunnar
dc.contributor.authorPenicka, Martin
dc.contributor.authorLinde, Cecilia
dc.contributor.authorAalen, Odd O.
dc.contributor.authorKongsgård, Erik
dc.contributor.authorGalli, Elena
dc.contributor.authorVoigt, Jens-Uwe
dc.contributor.authorSmiseth, Otto A.
dc.date.accessioned2021-02-10T16:04:12Z
dc.date.accessioned2021-03-15T09:11:02Z
dc.date.available2021-02-10T16:04:12Z
dc.date.available2021-03-15T09:11:02Z
dc.date.issued2020-09-11
dc.identifier.citationAalen, Donal, Larsen, Duchenne, Lederlin, Cvijic, Hubert, Voros, Leclercq, Bogaert, Hopp, Fjeld, Penicka, Linde, Aalen, Kongsgård, Galli, Voigt, Smiseth. Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance. European Heart Journal. 2020;41(39):3813-3823en
dc.identifier.issn0195-668X
dc.identifier.issn1522-9645
dc.identifier.urihttps://hdl.handle.net/10642/10045
dc.description.abstractAims: Left ventricular (LV) failure in left bundle branch block is caused by loss of septal function and compensatory hyperfunction of the LV lateral wall (LW) which stimulates adverse remodelling. This study investigates if septal and LW function measured as myocardial work, alone and combined with assessment of septal viability, identifies responders to cardiac resynchronization therapy (CRT). Methods and results: In a prospective multicentre study of 200 CRT recipients, myocardial work was measured by pressure-strain analysis and viability by cardiac magnetic resonance (CMR) imaging (n = 125). CRT response was defined as ≥15% reduction in LV end-systolic volume after 6 months. Before CRT, septal work was markedly lower than LW work (P < 0.0001), and the difference was largest in CRT responders (P < 0.001). Work difference between septum and LW predicted CRT response with area under the curve (AUC) 0.77 (95% CI: 0.70–0.84) and was feasible in 98% of patients. In patients undergoing CMR, combining work difference and septal viability significantly increased AUC to 0.88 (95% CI: 0.81–0.95). This was superior to the predictive power of QRS morphology, QRS duration and the echocardiographic parameters septal flash, apical rocking, and systolic stretch index. Accuracy was similar for the subgroup of patients with QRS 120–150 ms as for the entire study group. Both work difference alone and work difference combined with septal viability predicted long-term survival without heart transplantation with hazard ratio 0.36 (95% CI: 0.18–0.74) and 0.21 (95% CI: 0.072–0.61), respectively. Conclusion: Assessment of myocardial work and septal viability identified CRT responders with high accuracy.en
dc.description.sponsorshipThe study was supported by Center for Cardiological Innovation. J.M.A. was supported by a grant from the Norwegian Health Association. C.K.L. was recipient of a clinical research fellowship from the South-Eastern Norway Regional Health Authority. The study and J.D. were supported by a research grant of the University Leuven (OT12/084). J.-U.V. holds a research mandate of the Research Foundation Flanders (FKM1832917N).en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.ispartofseriesEuropean Heart Journal;Volume 41, Issue 39
dc.rightsCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licenseen
dc.subjectCardiac resynchronization therapiesen
dc.subjectDyssynchronyen
dc.subjectHeart failuresen
dc.subjectLeft bundle branch blocksen
dc.subjectMyocardial scarsen
dc.subjectMyocardial worksen
dc.titleImaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonanceen
dc.typeJournal articleen
dc.typePeer revieweden
dc.date.updated2021-02-10T16:04:12Z
dc.description.versionpublishedVersionen
dc.identifier.doihttps://doi.org/10.1093/eurheartj/ehaa603
dc.identifier.cristin1849425
dc.source.journalEuropean Heart Journal


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