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Left ventricular pacing vector selection by novel echo-particle imaging velocimetry analysis for optimization of quadripolar cardiac resynchronization device: A case report

Martiniello, Alfonso Robertor
•
PEDRIZZETTI, Gianni
•
Bianchi, Valter
altro
Caso, Pio
2016
  • journal article

Periodico
JOURNAL OF MEDICAL CASE REPORTS
Abstract
Background: The availability of pacing configurations offered by quadripolar left ventricular leads could improve patients’ response to cardiac resynchronization therapy; however, the selection of an optimal setting remains a challenge. Echo-particle imaging velocimetry has shown that regional anomalies of synchrony/synergy of the left ventricle are related to the alteration, reduction, or suppression of the physiological intracavitary pressure gradients. These observations are also supported by several numerical models of the left ventricle that have shown the close relationship between wall motion abnormalities, change of intraventricular flow dynamics, and abnormal distribution of forces operating on the ventricular endocardium. Case presentation: A 73-year-old white man in New York Heart Association III functional class with an ejection fraction of 27.5 % did not improve after 1 month of cardiac resynchronization therapy. Five configurations were tested and settings were defined by optimizing intraventricular flow. After 6 months, he became New York Heart Association II class with left ventricular ejection fraction of 53.2 %. Conclusions: The abnormal dynamic of pressure gradients during the cardiac cycle, through biohumoral endocrine, autocrine, and paracrine transduction, may lead to structural changes of the myocardial walls with subsequent left ventricular remodeling. The echo-particle imaging velocimetry technique may be useful for elucidating the favorable effects of cardiac resynchronization therapy on intraventricular fluid dynamics and it could be used to identify appropriate pacing setting during acute echocardiographic optimization of left pacing vector.
DOI
10.1186/s13256-016-0965-9
Archivio
http://hdl.handle.net/11368/2880612
info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-84979518520
http://www.jmedicalcasereports.com/articles/browse.asp
Diritti
open access
FVG url
https://arts.units.it/bitstream/11368/2880612/1/2016jmcr.pdf
Soggetti
  • Case report

  • CRT

  • Echo-PIV

  • Fluid dynamic

  • Quadripolar lead

  • RT3D-TTE

  • Vortex

  • Medicine (all)

Scopus© citazioni
5
Data di acquisizione
Jun 7, 2022
Vedi dettagli
google-scholar
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