The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ronald D Berger - One of the best experts on this subject based on the ideXlab platform.
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new insight into scar related ventricular tachycardia circuits in Ischemic Cardiomyopathy fat deposition after myocardial infarction on computed tomography a pilot study
Heart Rhythm, 2015Co-Authors: Takeshi Sasaki, Hugh Calkins, Christopher F Miller, Menekhem M Zviman, Vadim Zipunnikov, Tomio Arai, Motoji Sawabe, Masashiro Terashima, Joseph E Marine, Ronald D BergerAbstract:Background Myocardial fat deposition (FAT-DEP) has been frequently observed in regions of chronic myocardial infarction in patients with Ischemic Cardiomyopathy. The role of FAT-DEP within scar-related ventricular tachycardia (VT) circuits has not been investigated. Objective This pilot study aimed to assess the impact of myocardial FAT-DEP on local electrograms and VT circuits in patients with Ischemic Cardiomyopathy. Methods Contrast-enhanced computed tomography was performed in 22 patients with Ischemic VT. Electroanatomic map points were registered to the corresponding contrast-enhanced computed tomography images. Myocardial FAT-DEP was identified and characterized using a postprocessing image overlay that highlighted areas below 0 Hounsfield units (HU). The mean attenuation of local myocardial regions corresponding to sampled electrograms was measured on short-axis images. The associations of mean attenuation with bipolar and unipolar amplitudes, left ventricular wall thickness, and VT circuit sites were investigated. Results Of 1801 electroanatomic map points, 519 (28.8%) were located in regions with FAT-DEP. Significant differences were observed in mean intensity (23.2 ± 35.6 HU vs 81.7 ± 21.9 HU; P P P P P Conclusion FAT-DEP was associated with electrogram characteristics and VT circuit sites. Further work will be needed to determine whether FAT-DEP plays a causal role in the generation of Ischemic scar–related VT circuits.
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optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with Ischemic Cardiomyopathy
Journal of the American College of Cardiology, 2010Co-Authors: David D Spragg, Joseph E Marine, Jun Dong, Barry J Fetics, Robert H Helm, Alan Cheng, Charles A Henrikson, David A Kass, Ronald D BergerAbstract:Objectives We sought to investigate the impact of left ventricular (LV) pacing site on mechanical response to cardiac resynchronization therapy (CRT) in patients with Ischemic Cardiomyopathy (ICM). Background CRT reduces morbidity and mortality in patients with dyssynchronous LV failure; however, variability in response, particularly in ICM patients, poses ongoing challenges. Endocardial biventricular (BiV) stimulation may provide more flexibility in LV site selection and yield more natural transmural activation patterns. Whether this applies to ICM and whether optimal LV endocardial pacing locations vary among ICM patients remain unknown. Methods Peak rate of LV pressure increase (dP/dt max ) was measured at baseline, during VDD pacing at the right ventricular apex, and during BiV pacing from the right ventricular apex and 51 ± 14 different LV endocardial sites in patients with ICM (n = 11). Seven patients already had an epicardial LV lead (CRT) in place, allowing comparison of epicardial BiV stimulation with that using an endocardial site directly transmural to the CRT-coronary sinus lead tip. Electroanatomic 3-dimensional maps with color-coded dP/dt max response defined optimal pacing regions delivering ≥85% of maximal increase in dP/dt max . Results Endocardial BiV pacing improved dP/dt max over right ventricular apex pacing in all patients (mean increase 241 ± 38 mm Hg/s; p max values. However, dP/dt max at the best endocardial site exceeded that achieved with the pre-implanted CRT device (mean increase 111 ± 25 mm Hg/s; p = 0.004). An average of ∼2 optimal endocardial sites were identified for each patient, located at the extreme basal lateral wall (8 of 11 patients) and other regions (9 of 11). Standard mid-LV free wall pacing yielded suboptimal LV function in 73% of patients. Optimal pacing sites were typically located in LV territories remote (9.3 ± 3.6 cm) from the infarct zone. Conclusions CRT delivered at best LV endocardial sites is more effective than via pre-implanted coronary sinus lead pacing. The location of optimal LV endocardial pacing varies among patients with ICM, and individual tailoring may improve CRT efficacy in such patients.
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optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with Ischemic Cardiomyopathy
Journal of the American College of Cardiology, 2010Co-Authors: David D Spragg, Joseph E Marine, Jun Dong, Barry J Fetics, Robert H Helm, Alan Cheng, Charles A Henrikson, David A Kass, Ronald D BergerAbstract:Objectives We sought to investigate the impact of left ventricular (LV) pacing site on mechanical response to cardiac resynchronization therapy (CRT) in patients with Ischemic Cardiomyopathy (ICM). Background CRT reduces morbidity and mortality in patients with dyssynchronous LV failure; however, variability in response, particularly in ICM patients, poses ongoing challenges. Endocardial biventricular (BiV) stimulation may provide more flexibility in LV site selection and yield more natural transmural activation patterns. Whether this applies to ICM and whether optimal LV endocardial pacing locations vary among ICM patients remain unknown. Methods Peak rate of LV pressure increase (dP/dt max ) was measured at baseline, during VDD pacing at the right ventricular apex, and during BiV pacing from the right ventricular apex and 51 ± 14 different LV endocardial sites in patients with ICM (n = 11). Seven patients already had an epicardial LV lead (CRT) in place, allowing comparison of epicardial BiV stimulation with that using an endocardial site directly transmural to the CRT-coronary sinus lead tip. Electroanatomic 3-dimensional maps with color-coded dP/dt max response defined optimal pacing regions delivering ≥85% of maximal increase in dP/dt max . Results Endocardial BiV pacing improved dP/dt max over right ventricular apex pacing in all patients (mean increase 241 ± 38 mm Hg/s; p max values. However, dP/dt max at the best endocardial site exceeded that achieved with the pre-implanted CRT device (mean increase 111 ± 25 mm Hg/s; p = 0.004). An average of ∼2 optimal endocardial sites were identified for each patient, located at the extreme basal lateral wall (8 of 11 patients) and other regions (9 of 11). Standard mid-LV free wall pacing yielded suboptimal LV function in 73% of patients. Optimal pacing sites were typically located in LV territories remote (9.3 ± 3.6 cm) from the infarct zone. Conclusions CRT delivered at best LV endocardial sites is more effective than via pre-implanted coronary sinus lead pacing. The location of optimal LV endocardial pacing varies among patients with ICM, and individual tailoring may improve CRT efficacy in such patients.
Jun Dong - One of the best experts on this subject based on the ideXlab platform.
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optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with Ischemic Cardiomyopathy
Journal of the American College of Cardiology, 2010Co-Authors: David D Spragg, Joseph E Marine, Jun Dong, Barry J Fetics, Robert H Helm, Alan Cheng, Charles A Henrikson, David A Kass, Ronald D BergerAbstract:Objectives We sought to investigate the impact of left ventricular (LV) pacing site on mechanical response to cardiac resynchronization therapy (CRT) in patients with Ischemic Cardiomyopathy (ICM). Background CRT reduces morbidity and mortality in patients with dyssynchronous LV failure; however, variability in response, particularly in ICM patients, poses ongoing challenges. Endocardial biventricular (BiV) stimulation may provide more flexibility in LV site selection and yield more natural transmural activation patterns. Whether this applies to ICM and whether optimal LV endocardial pacing locations vary among ICM patients remain unknown. Methods Peak rate of LV pressure increase (dP/dt max ) was measured at baseline, during VDD pacing at the right ventricular apex, and during BiV pacing from the right ventricular apex and 51 ± 14 different LV endocardial sites in patients with ICM (n = 11). Seven patients already had an epicardial LV lead (CRT) in place, allowing comparison of epicardial BiV stimulation with that using an endocardial site directly transmural to the CRT-coronary sinus lead tip. Electroanatomic 3-dimensional maps with color-coded dP/dt max response defined optimal pacing regions delivering ≥85% of maximal increase in dP/dt max . Results Endocardial BiV pacing improved dP/dt max over right ventricular apex pacing in all patients (mean increase 241 ± 38 mm Hg/s; p max values. However, dP/dt max at the best endocardial site exceeded that achieved with the pre-implanted CRT device (mean increase 111 ± 25 mm Hg/s; p = 0.004). An average of ∼2 optimal endocardial sites were identified for each patient, located at the extreme basal lateral wall (8 of 11 patients) and other regions (9 of 11). Standard mid-LV free wall pacing yielded suboptimal LV function in 73% of patients. Optimal pacing sites were typically located in LV territories remote (9.3 ± 3.6 cm) from the infarct zone. Conclusions CRT delivered at best LV endocardial sites is more effective than via pre-implanted coronary sinus lead pacing. The location of optimal LV endocardial pacing varies among patients with ICM, and individual tailoring may improve CRT efficacy in such patients.
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optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with Ischemic Cardiomyopathy
Journal of the American College of Cardiology, 2010Co-Authors: David D Spragg, Joseph E Marine, Jun Dong, Barry J Fetics, Robert H Helm, Alan Cheng, Charles A Henrikson, David A Kass, Ronald D BergerAbstract:Objectives We sought to investigate the impact of left ventricular (LV) pacing site on mechanical response to cardiac resynchronization therapy (CRT) in patients with Ischemic Cardiomyopathy (ICM). Background CRT reduces morbidity and mortality in patients with dyssynchronous LV failure; however, variability in response, particularly in ICM patients, poses ongoing challenges. Endocardial biventricular (BiV) stimulation may provide more flexibility in LV site selection and yield more natural transmural activation patterns. Whether this applies to ICM and whether optimal LV endocardial pacing locations vary among ICM patients remain unknown. Methods Peak rate of LV pressure increase (dP/dt max ) was measured at baseline, during VDD pacing at the right ventricular apex, and during BiV pacing from the right ventricular apex and 51 ± 14 different LV endocardial sites in patients with ICM (n = 11). Seven patients already had an epicardial LV lead (CRT) in place, allowing comparison of epicardial BiV stimulation with that using an endocardial site directly transmural to the CRT-coronary sinus lead tip. Electroanatomic 3-dimensional maps with color-coded dP/dt max response defined optimal pacing regions delivering ≥85% of maximal increase in dP/dt max . Results Endocardial BiV pacing improved dP/dt max over right ventricular apex pacing in all patients (mean increase 241 ± 38 mm Hg/s; p max values. However, dP/dt max at the best endocardial site exceeded that achieved with the pre-implanted CRT device (mean increase 111 ± 25 mm Hg/s; p = 0.004). An average of ∼2 optimal endocardial sites were identified for each patient, located at the extreme basal lateral wall (8 of 11 patients) and other regions (9 of 11). Standard mid-LV free wall pacing yielded suboptimal LV function in 73% of patients. Optimal pacing sites were typically located in LV territories remote (9.3 ± 3.6 cm) from the infarct zone. Conclusions CRT delivered at best LV endocardial sites is more effective than via pre-implanted coronary sinus lead pacing. The location of optimal LV endocardial pacing varies among patients with ICM, and individual tailoring may improve CRT efficacy in such patients.
Soon J Park - One of the best experts on this subject based on the ideXlab platform.
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management of severe Ischemic Cardiomyopathy left ventricular assist device as destination therapy versus conventional bypass and mitral valve surgery
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Simon Maltais, Vahtang Tchantchaleishvili, Hartzell V Schaff, Richard C Daly, Rakesh M Suri, Joseph A Dearani, Yan Topilsky, John M Stulak, Lyle D Joyce, Soon J ParkAbstract:Objectives Patients with severe Ischemic Cardiomyopathy (left ventricular ejection fraction Methods We identified patients who underwent conventional surgery or left ventricular assist device as destination therapy for severe Ischemic Cardiomyopathy (left ventricular ejection fraction Results A total of 88 patients were identified; 55 patients underwent conventional surgery (63%), and 33 patients (37%) received a left ventricular assist device as destination therapy. Patients who received left ventricular assist device as destination therapy had the increased prevalence of renal failure, inotrope dependency, and intra-aortic balloon support. Patients undergoing conventional surgery required longer ventilatory support, and patients receiving a left ventricular assist device required more reoperation for bleeding. Mortality rates were similar between the 2 groups at 30 days (7% in the conventional surgery group vs 3% in the left ventricular assist device as destination therapy group, P = .65) and at 1 year (22% in the conventional surgery group vs 15% in the left ventricular assist device as destination therapy group, P = .58). There was a trend toward improved survival in patients receiving a left ventricular assist device compared with the propensity-matched groups at 1 year (94% vs 71%, P = .171). Conclusions The operative mortality and early survival after conventional surgery seem to be acceptable. For inoperable or prohibitive-risk patients, left ventricular assist device as destination therapy can be offered with similar outcomes.
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mitral regurgitation surgery in patients with Ischemic Cardiomyopathy and Ischemic mitral regurgitation factors that influence survival
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Simon Maltais, Hartzell V Schaff, Richard C Daly, Rakesh M Suri, Joseph A Dearani, Yan Topilsky, Thoralf M Sundt, Maurice Enriquezsarano, Soon J ParkAbstract:Objective The treatment of patients with Ischemic Cardiomyopathy and concomitant mitral regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of mitral valve repair versus replacement in this high-risk population. Methods From 1993 to 2007, 431 patients (mean age, 70 ± 9 years) with Ischemic Cardiomyopathy (left ventricular ejection fraction ≤ 45%) and significant Ischemic mitral regurgitation (>2) were identified. Patients (44) with concomitant mitral stenosis were excluded from the analysis. A homogeneous group of 387 patients underwent combined coronary artery bypass grafting and mitral valve surgery, mitral valve repair in 302 (78%) and mitral valve replacement in 85 (22%). Uni- and multivariate analyses were performed on the entire cohort, and the predictors of mortality were identified in 2 distinct risk phases. Furthermore, we specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. Results Follow-up was 100% complete (median, 3.6 years; range, 0–15 years). Overall 1-, 5-, and 10-year survivals were 82.7%, 55.2%, and 24.3%, respectively, for the entire group. The risk factors for an increased mortality within the first year of surgery included previous coronary artery bypass grafting (hazard ratio = 3.39; P P = .007), age (hazard ratio = 1.5; P = .03), and low left ventricular ejection fraction (hazard ratio = 1.31; P = .026). Thereafter, only age (hazard ratio = 1.58; P P = .001), and preoperative renal insufficiency (hazard ratio = 1.72; P = .025) were predictive. The status of mitral valve repair versus replacement did not influence survival, and this was confirmed by comparable survival in propensity-matched analyses. Conclusions Survival after combined coronary artery bypass grafting and mitral valve surgery in patients with Ischemic Cardiomyopathy (left ventricular ejection fraction ≤ 45%) and mitral regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of mitral valve repair versus replacement did not seem to affect survival.
Eric J Velazquez - One of the best experts on this subject based on the ideXlab platform.
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optimal medical therapy with or without surgical revascularization and long term outcomes in Ischemic Cardiomyopathy
The Journal of Thoracic and Cardiovascular Surgery, 2021Co-Authors: Pedro S Farsky, Christopher M Oconnor, Julio A Panza, Hussein R Alkhalidi, Jennifer White, Carla A Sueta, Jean L Rouleau, Eric J Velazquez, Rafal Dabrowski, Ljubomir T DjokovicAbstract:Abstract Objectives Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with Ischemic Cardiomyopathy. Methods The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug. Results At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation. Conclusions Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with Ischemic Cardiomyopathy and should be strongly recommended.
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implication of right ventricular dysfunction on long term outcome in patients with Ischemic Cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction
The Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Tomasz Kukulski, Julio A Panza, Eric J Velazquez, Lilin She, Normand Racine, Sinisa Gradinac, Kwan Chan, Mark C Petrie, Kerry L LeeAbstract:Objective Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with Ischemic Cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Methods Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Results Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality ( P = .022). Conclusions Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with Ischemic Cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.
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long term survival of patients with Ischemic Cardiomyopathy treated by coronary artery bypass grafting versus medical therapy
The Annals of Thoracic Surgery, 2012Co-Authors: Eric J Velazquez, Linda K Shaw, Christopher M Oconnor, Kerry L Lee, Judson B Williams, Eric Yow, Harry R Phillips, Peter K Smith, Robert H JonesAbstract:Background We prospectively applied the Surgical Treatment of Ischemic Cardiomyopathy trial entry criteria to an observational database to determine whether coronary artery bypass grafting (CABG) decreases mortality compared with medical therapy (MED) for patients with coronary artery disease and depressed left ventricular ejection fraction. Methods This was a retrospective, observational, cohort study of prospectively collected data from the Duke Databank for Cardiovascular Disease. Long-term mortality was the main outcome measure. Between January 1, 1995, and July 31, 2009, 86,874 patients underwent cardiac catheterization for suspected Ischemic heart disease and were evaluated for inclusion in the analysis. Results A total of 2,624 patients were found to have left ventricular ejection fraction less than 0.35, coronary artery disease amenable to CABG, and no left main stenosis of greater than 50%. After exclusions including ongoing Canadian Cardiovascular Society class III angina and acute myocardial infarction, 763 patients were included for propensity score analysis, including 624 who received MED and 139 who underwent CABG. Adjusted mortality curves were constructed for those patients in the three quintiles most likely to receive CABG. The curves diverged early, with risk-adjusted mortality rates at 5 years of 46% for MED versus 29% for CABG, and the survival benefit of CABG over MED continued through 10 years of follow-up (hazard ratio, 0.63; 95% confidence interval, 0.45 to 0.88). Conclusions Among a propensity-matched, risk-adjusted, observational cohort of patients with coronary artery disease, left ventricular ejection fraction less than 0.35, and no left main disease of greater than 50%, CABG is associated with a survival advantage over MED through 10 years of follow-up.
Deborah H. Kwon - One of the best experts on this subject based on the ideXlab platform.
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predictors and prognostic significance of right ventricular ejection fraction in patients with Ischemic Cardiomyopathy
Circulation, 2016Co-Authors: Marwa A Sabe, Scott D. Flamm, Sharif Sabe, Kenya Kusunose, Brian P Griffin, Deborah H. KwonAbstract:Background —Decreased right ventricular ejection fraction (RVEF) portends poor prognosis in patients with Ischemic Cardiomyopathy and previous studies have suggested an association between mitral regurgitation (MR) and RVEF. We sought to evaluate this association as well as whether mitral valve repair or replacement (MVrR) affects the relationship between RV function and mortality. Methods —We included 588 patients (mean age 63 +/- 11 yr; 75% male) with Ischemic Cardiomyopathy who underwent cardiac MRI between 2002-2008. Baseline characteristics, left ventricular ejection fraction (LVEF), MR severity, treatment modality, scar burden, and RVEF were assessed. Multivariable linear regression and Cox proportional hazards models were used to assess the association between MR and RVEF and RVEF and mortality, respectively. Results —After adjusting for age, gender, LVEF, right bundle branch block (RBBB), and RV scar, MR severity was found to be independently associated with RVEF. There were a total of 240 deaths over a median follow-up time of 5.7 years. After multivariable adjustment, every 10% decrease in RVEF was associated with a 17% increased risk of death (p=0.008). Although decreasing RVEF was associated with a poor prognosis in the non-repair group (HR 1.28 [1.12-1.47], p<0.001), it was not associated with death in the MVrR group (p for interaction 0.046). Conclusions —MR severity was found to be an independent predictor of RVEF, as were RBBB, LVEF, and the presence of RV scar. Decreasing RVEF is associated with increased mortality in patients with Ischemic Cardiomyopathy; however this association may be mitigated in patients who undergo MVrR.
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Survival in Patients With Severe Ischemic Cardiomyopathy Undergoing Revascularization Versus Medical Therapy Association With End-Systolic Volume and Viability
Circulation, 2012Co-Authors: Deborah H. Kwon, Zoran B. Popović, Milind Y. Desai, Scott D. Flamm, Rory Hachamovitch, Randall C. Starling, Bruce W. Lytle, Thomas H. MarwickAbstract:Background—The value of assessment of viability as a predictor of surgical revascularization benefit in Ischemic Cardiomyopathy has recently been questioned in a large trial. We sought to determine whether the contribution of viability as myocardial scar burden (SB) to predict revascularization outcomes could be modulated by end-systolic volume index (ESVi). Methods and Results—Delayed hyperenhancement–MRI was obtained in 450 patients with ≥70% stenosis in ≥1 epicardial coronary artery (75% men; median age, 62.8±10.7 years; mean left ventricular ejection fraction, 23±9%; mean ESVi, 115±50 mL) from 2002 to 2006. SB was quantified as scar percentage (infarcted mass/total left ventricular mass). Subsequent surgical revascularization was performed in 245 (54%) patients and subsequent percutaneous coronary interventions were performed in 28 (6%) patients. A propensity score was developed for revascularization. Cox proportional hazards models of all-cause mortality were used for risk adjustment. Over a mean fol...
