Systolic thickening fraction of inerventricular septum as a predictor of superresponse to cardiac resyncronisation therapy - concept of a helical ventriсular band

Aim: to assess morpho-functional properties of left ventricle (LV) in patients with superresponse (SR) to CRT using the helical ventriсular band concept (HVB).

Materials and methods: 56 patients were examined (mean age 54.0±9.9 years) at baseline and during follow-up visit: 48.8±25.6 months. Patients were divided into groups: I group (n=34) with decrease of LV end-systolic volume (ESV) ≥30% (superresponders) and II group (n=22) - decrease of LV ESV ˂30% (nonsuperresponders).

Results: apical loop descendens segment (DS) and ascendens segment (AS) of HVB were evaluated according to the concept of F. Torrent-Guasp et al. According to the logistic regression mechanical interventricular delay (MID) (OR 1.072, 95% CI 1.017-1.131; p=0.01) and systolic thickening fraction (STF) of interventricular septum (IVS) DS (OR 0.944, 95% CI 0.895 - 0.995; p = 0.033) had an independent relationship with CRT SR. According to the ROC analysis the sensitivity and specificity of this model were 72.7% and 66.7% (AUC=0.769; р=0.001). AS STF of IVS was higher in SR (22.5 [0.0;40.0]% и 0.0 [0.0;25.0]%; р=0.005). The survival rate in group I was 85.1%, in group II was 63.6% (Log-Rank test p=0.019).

Conclusion: SR is associated with a higher AS STF of IVS, higher MID, also with a higher survival rate.

1. Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC Guidelines on cardiac pacing and cardiac resynchronization therapy 2013 The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). European heart journal. 2013;34(29): 2281-329. DOI: 10.1093/eurheartj/eht150.

2. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016;37: 2129-2200. DOI: 10.1093/eurheartj/ehw128.

3. Galli E, Leclercq C, Donal E. Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment? Archives of cardiovascular diseases. 2017;110(1): 60-68. DOI: 10.1016/j.acvd.2016.12.002.

4. Rickard J, Kumbhani DJ, Popovic Z, et al. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm. 2010;7: 885-9. DOI: 10.1016/j.hrthm.2010.04.005.

5. Risum N. Assessment of mechanical dyssynchrony in cardiac resynchronization therapy. Dan Med J. 2014;61(12): B4981.

6. Torrent-Guasp F, Ballester M, Buckberg GD, et al. Spatial orientation of the ventricular muscle band: physiologic contribution and surgical implications. J Thorac Cardiovasc Surg. 2001;122: 389-392.

7. Kocica MJ, Corno AF, Carreras-Costa F, et al. The helical ventricular myocardial band: global, three-dimensional, functional architecture of the ventricular myocardium. European journal of cardio-thoracic surgery. 2006;29: 21-40.

8. Kuznetsov VA, Kolunin GV, Kharats VE et al. Register of performed operations of cardiac resynchronization therapy. Electronic database, state registration №2010620077 from 01.02.2010 (In Russ.).

9. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15): 1539-49. DOI: 10.1056/NEJMoa050496.

10. Mareev VYu, Fomin IV, Ageev FT, et al. Clinical recommendations SSHF-RSC-RSMST. Heart failure: congestive (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiya. 2018; 58(6S): 8-158. (In Russ). DOI: 10.18087/cardio.2475.

11. Kuznetsov V.A. Cardiac resynchronisation therapy: selected questions. M.: “Abys”, 2007. - 128p. (In Russ).

12. Hayabuchi Y, Sakata M, Kagami S. Assessment of the helical ventricular myocardial band using standard echocardiography. Echocardiography. 2015;32(2): 310-318. DOI: 10.1111/echo.12624.

13. Jackson T, Sohal M, Chen Z, et al. A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy. Heart rhythm. 2014;11(10): 1790. DOI: 10.1016/j.hrthm.2014.06.005.

14. Kuznetsov V. Echocardiographic measurement of left and right portion of interventricular septum. Necroscopy validation. Eur J Echocardiography. Euroecho 4 Abstracts Supplement. 2000; S22.

15. Ruschitzka F, Abraham WT, Singh JP, et al. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. New England Journal of Medicine. 2013;369(15): 1395-1405. DOI: 10.1056/NEJMoa1306687.

16. van Bommel RJ, Bax JJ, Abraham WT, et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J. 2009;30(20): 2470-7. DOI: 10.1093/eurheartj/ehp368.

17. Auricchio A, Fantoni C, Regoli F, et al. Characterization of left ventricular activation in patients with heart failure and left bundle branch block. Circulation. 2004;109: 1133-9. DOI: 10.1161/01.CIR.0000118502.91105.F6.

18. Saba S, Marek J, Schwartzman D, et al. Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy: results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region trial. Circ. Heart Fail. 2013;6: 427-434. DOI: 10.1161/CIRCHEARTFAILURE.112.000078.

19. Khan FZ, Virdee MS, Palmer CR, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial. J Am Coll Cardiol. 2012; 59(17): 1509-1518. DOI: 10.1016/j.jacc.2011.12.030.

20. van Bommel RJ, Ypenburg C, Mollema SA, et al. Site of latest activation in patients eligible for cardiac resynchronization therapy: patterns of dyssynchrony among different QRS configurations and impact of heart failure etiology. American heart journal. 2011;161(6): 1060-1066. DOI: 10.1016/j.ahj.2011.03.014.

21. Buckberg G, Nanda N, Nguyen C, et al. What is the heart? Anatomy, function, pathophysiology, and misconceptions. Journal of cardiovascular development and disease. 2018; 5(2): 33. DOI: 10.3390/jcdd5020033.

22. Shirokov NE, Kuznetsov VA, Soldatova AM, et al. Comparative analysis of patients with cardiac resynchronization therapy depending on septal flash presence. Medical visualization. 2019;23(3):44-53. (In Russ.). DOI: 10.24835/1607-0763-2019-3-44-53.

23. van der Heijden AC, Hoke U, Thijssen J, et al. Longterm echocardiographic outcome in super-responders to cardiac resynchronization therapy and the association with mortality and defibrillator therapy. American journal of cardiology. 2016;118(8):1217-1224. DOI: 10.1016/j.amjcard.2016.07.041.

24. Rickard J, Cheng A, Spragg D, et al. Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: fate of “nonresponders”. Heart Rhythm. 2014;11(3): 412-6. DOI: 10.1016/j.hrthm.2013.11.025.

25. Kuznetsov VA, Soldatova AM, Krinochkin DV et al. Cardiac resynchronisation therapy in patients with congestive heart failure: whether we should expect for an “early” response? Russian Heart Failure Journal. 2017;18(3): 172-177. (In Russ). DOI: 10.18087/rhfj.2017.3.2341.

26. Chiang KF, Cheng CM, Tsai S, et al. Relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging and cardiac reverse remodeling levels after cardiac resynchronization therapy. Ann Nucl Med. 2016;30: 484-93. DOI: 10.1007/s12149-016-1083-x.