Speckle-tracking strain echocardiography for detecting cardiac dyssynchrony in a canine model of dyssynchrony and heart failure.

Multiple echocardiographic criteria have been proposed to diagnose mechanical dyssynchrony in patients with heart failure without being validated against a model of cardiac dyssynchrony with heart failure. This study examines which of these methods can detect dyssynchrony in a canine model. Adult mongrel dogs underwent His-bundle ablation and right-ventricular pacing for 4 wk at either 110 bpm to induce dyssynchrony without heart failure (D group, n = 12) or 170 bpm to induce dyssynchrony with heart failure (DHF group, n = 9). To induce heart failure with narrow QRS, atria were paced at 190 bpm for 4 wk (HF group, n = 8). Tissue Doppler imaging (TDI) and two-dimensional echocardiography were performed at baseline and at end of study. Standard deviation of time to peak systolic velocity (color-coded TDI), time to peak S wave on pulse-wave TDI, time to peak radial and circumferential strain by speckle-tracking analysis (E(rr) and E(cc), respectively), and septal-to-posterior wall motion delay on M mode were obtained. In D group, only E(rr) and E(cc) were increased by dyssynchrony. In contrast, all the echocardiographic parameters of dyssynchrony appeared significantly augmented in the DHF group. Receiver-operator curve analysis showed good sensitivity of E(rr) (90%) and E(cc) (100%) to detected dyssynchrony without heart failure and excellent sensitivity and specificity of E(rr) and E(cc) to detect dyssynchrony with heart failure. Radial strain by speckle tracking is more accurate than TDI velocity to detect cardiac dyssynchrony in a canine model of dyssynchrony with or without heart failure.

Effects of single-site versus biventricular epicardial pacing on myocardial performance in an immature animal model of atrioventricular block.

INTRODUCTION: Single-site ventricular pacing results in dyssynchronous ventricular activation and may contribute to ventricular dysfunction. We evaluated epicardial biventricular (BiV) pacing as a means of maintaining synchronous ventricular activation in an acute piglet model of AV block with normal ventricular anatomy and function. METHODS AND RESULTS: We used left ventricular (LV) impedance catheters and tissue Doppler imaging to assess the cardiodynamics of immature piglets (n = 6, 33-78 days, 9.35 +/- 0.85 kg). Following catheter ablation of the AV node, a pacemaker was programmed 20 beats per minute above the intrinsic atrial rate. The animals were paced at 5-minute intervals via the following AV sequential configurations: Right atrial appendage (RA)-RV apex (RVA), RA-LV apex (LVA), and RA-biventricular (RVA/LVA). RA-RVA was the experimental control. LV systolic mechanics, measured by the slope of the end-systolic pressure-volume relationship (E(es)), increased with BiV pacing (12.8 +/- 3.4 mmHg/mL, P < 0.02) or single-site LVA pacing (10.6 +/- 3.4 mmHg/mL, P < 0.05) compared with single-site RVA pacing (8.3 +/- 1.4 mmHg/mL). QRS duration lengthened compared with sinus rhythm (42 +/- 8 msec) with either RVA (56 +/- 9 msec, P < 0.02) or LVA (54 +/- 7 msec, P < 0.03), but not with BiV (48 +/- 7 msec, P = 0.08) pacing. Tissue Doppler imaging showed LV dyssynchrony with RVA (septal-to-lateral delay 46.0 +/- 51.7 msec), with return toward normal with LVA (-9.6 +/- 33.6 msec, P < 0.04) or BiV (-4.1 +/- 33.8 msec, P < 0.04) pacing. CONCLUSIONS: In this acute immature piglet model of AV block, LV performance improved with single-site pacing from the LVA and BiV pacing (RVA/LVA), as compared with single-site pacing from the RVA. These changes correlated with tissue Doppler indices of mechanical synchrony, though not necessarily with QRS duration.

Evaluation of myocardial performance with conventional single-site ventricular pacing and biventricular pacing in a canine model of atrioventricular block.

INTRODUCTION: The aim of this study was to evaluate epicardial biventricular pacing as a means of maintaining synchronous ventricular activation in an acute canine model of AV block with normal ventricular anatomy and function. Chronic single-site ventricular pacing results in dyssynchronous ventricular activation and may contribute to ventricular dysfunction. Biventricular pacing has been used successfully in adult patients with congestive heart failure. METHODS AND RESULTS: This was an acute study of open chest mongrel dogs (n = 13). ECG, left ventricular (LV), aortic, and pulmonary arterial pressures were measured. LV impedance catheters were used to assess cardiodynamics using instantaneous LV pressure-volume relations (PVR). Following radiofrequency ablation of the AV node, a temporary pacemaker was programmed 10 beats/min above the intrinsic atrial rate, with an AV interval similar to the baseline intrinsic PR interval. The pacing protocol consisted of 5-minute intervals with the following lead configurations: right atrium-right ventricular apex (RA-RVA), RA-LV apex (LVA), and RA-biventricular using combinations of four ventricular sites (RVA, RV outflow tract [RVOT], LVA, LV base [LVB]). RA-RVA was used as the experimental control. LV systolic mechanics, as measured by the slope of the end-systolic (Ees) PVR (ESPVR, mmHg/cc), was statistically greater (P < 0.05) with all modes of biventricular pacing (RA-RVA/LVA 20.0 +/- 2.9, RA-RVA/LVB 18.4 +/- 2.9, RA-RVOT/LVA 15.1 +/- 1.8, RA-RVOT/LVB 17.6 +/- 2.9) compared to single-site ventricular pacing (RA-RVA 12.8 +/- 1.6). Concurrent with this improvement in myocardial performance was a shortening of the QRS duration (RA-RVA 97.7 +/- 2.9 vs RA-RVA/LVA 75.7 +/- 4.9, RA-RVA/LVB 70.3 +/- 4.9, RA-RVOT/LVA 65.3 +/- 4.4, and RA-RVOT/LVB 76.7 +/- 5.9, P < 0.05). CONCLUSION: In this acute canine model of AV block, QRS duration shortened and LV performance improved with epicardial biventricular pacing compared to standard single-site ventricular pacing.