This Article Full Text (PDF) Figure Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Curry, C. W. Articles by Kass, D. A. Search for Related Content PubMed PubMed Citation Articles by Curry, C. W. Articles by Kass, D. A. Related Collections Congestive Pacemaker CT and MRI

(Circulation. 2000;101:e2.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Mechanical Dyssynchrony in Dilated Cardiomyopathy With Intraventricular Conduction Delay as Depicted by 3D Tagged Magnetic Resonance Imaging

Cecilia W. Curry, MSE; Gregory S. Nelson, PhD; Bradley T. Wyman, PhD; Jerome Declerck, PhD; Maurice Talbot, RN; Ronald D. Berger, MD, PhD; Elliot R. McVeigh, PhD; David A. Kass, MD

From the Division of Cardiology, the Department of Medicine (C.W.C., G.S.N., M.T., R.D.B., D.A.K.), the Department of Biomedical Engineering (B.T.W., J.D., E.R.M., D.A.K.), and the Department of Radiology (E.R.M.), The Johns Hopkins Medical Institutions, Baltimore, Md.

Correspondence to David A. Kass, MD, Halsted 500, the Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287. E-mail dkass{at}bme.jhu.edu

	Introduction

Top Introduction References

 
Recent studies have generated interest in the potential for left or biventricular pacing to improve cardiac function in patients with dilated cardiomyopathy and intraventricular conduction delays.^{1 2 3 4} The premise is that these hearts display profound basal mechanical dyssynchrony and that pacing can restore synchronization and, thereby, improve function. Here, we demonstrate the extent of mechanical dyssynchrony in such patients. Images were generated by tagged magnetic resonance imaging,^{5 6 7} which offers a unique noninvasive tool for determining and displaying high-resolution 3D wall motion in patients. Two images are displayed in the Figure: on the left, a normal control patient is seen, and to the right, a patient with severe cardiomyopathy and left bundle branch morphology conduction delay is shown (each image is activated by double clicking over it with the mouse). During systolic contraction, the colors change, reflecting the distribution and timing of regional circumferential strains. Red coding corresponds to the diastolic relaxed state; shortening, by a transition from red to blue; and stretch, by red to yellow. In the normal heart, contraction is synchronous within the myocardium, with a normal symmetric distribution of negative strain (-20% by end-systole) across the wall. In contrast, the contraction pattern is markedly dyssynchronous in the heart with dilated cardiomyopathy. Myocardium in the septal region (green dot denotes septum) becomes first blue in early systole and then yellow (ie, stretching) in late systole. Contraction slowly spreads to the lateral wall as the septum develops positive strains. The temporal magnitude of dyssynchrony is substantial. In this and other such patients, ventricular free wall (or biventricular) pacing with preexcitation^{1 2 3 4} enhances the systolic function of the heart.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

	References

Top Introduction References

 

1. Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, Benditt DG, Lurie KG. Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation. 1997;96:3273–3277.[Abstract/Free Full Text]
   
2. Leclercq C, Cazeau S, Le Breton H, Ritter P, Mabo P, Gras D, Pavin D, Lazarus A, Daubert JC. Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol. 1998;32:1825–1831.[Abstract/Free Full Text]
   
3. Kass DA, Chen C-H, Curry C, Talbot M, Berger R, Fetics B, Nevo E. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567–1573.[Abstract/Free Full Text]
   
4. Auricchio A, Stellbrink C, Block M, Sack S, Vogt J, Bakker P, Klein H, for the Pacing Therapies for Congestive Heart Failure Study Group, Kramer A, Ding J, Salo R, Tockman B, Poochet T, Spinelli J, for the Guidant Congestive Heart Failure Research Group. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation. 1999;99:2993–3001.[Abstract/Free Full Text]
   
5. McVeigh ER, Atalar E. Cardiac tagging with breath-hold cine MRI. Magn Reson Med. 1992;28:318–327.[Medline] [Order article via Infotrieve]
   
6. McVeigh ER. Regional myocardial function. Cardiol Clin. 1998;16:189–206.[Medline] [Order article via Infotrieve]
   
7. McVeigh ER, Prinzen FW, Wyman BT, Tsitlik JE, Halperin HR, Hunter WC. Imaging asynchronous mechanical activation of the paced heart with tagged MRI. Magn Reson Med. 1998;39:507–513.[Medline] [Order article via Infotrieve]
   

This article has been cited by other articles:

				A Y Patwala and D J Wright Device based treatment of heart failure Postgrad. Med. J., May 1, 2005; 81(955): 286 - 291. [Abstract] [Full Text] [PDF]

				P D Lambiase, A Rinaldi, J Hauck, M Mobb, D Elliott, S Mohammad, J S Gill, and C A Bucknall Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy Heart, January 1, 2004; 90(1): 44 - 51. [Abstract] [Full Text] [PDF]

				T. V. Salukhe, M. Y. Henein, and R. Sutton Pacing in heart failure: patient and pacing mode selection Eur. Heart J., June 1, 2003; 24(11): 977 - 986. [Full Text] [PDF]

				M. Kawaguchi, T. Murabayashi, B. J. Fetics, G. S. Nelson, H. Samejima, E. Nevo, and D. A. Kass Quantitation of basal dyssynchrony and acute resynchronization from left or biventricular pacing by novel echo-contrast variability imaging J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2052 - 2058. [Abstract] [Full Text] [PDF]

				C. Leclercq and D. A. Kass Retiming the failing heart: principles and current clinical status of cardiac resynchronization J. Am. Coll. Cardiol., January 16, 2002; 39(2): 194 - 201. [Abstract] [Full Text] [PDF]

				G. S. Nelson, R. D. Berger, B. J. Fetics, M. Talbot, J. C. Spinelli, J. M. Hare, and D. A. Kass Left Ventricular or Biventricular Pacing Improves Cardiac Function at Diminished Energy Cost in Patients With Dilated Cardiomyopathy and Left Bundle-Branch Block Circulation, December 19, 2000; 102(25): 3053 - 3059. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Figure Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Curry, C. W. Articles by Kass, D. A. Search for Related Content PubMed PubMed Citation Articles by Curry, C. W. Articles by Kass, D. A. Related Collections Congestive Pacemaker CT and MRI