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Open Access 01-12-2019 | Transthoracic Echocardiography | Case report

Combined flow-based imaging assessment of optimal cardiac resynchronization therapy pacing vector: a case report

Authors: A. R. Martiniello, V. Bianchi, G. Tonti, C. Cioppa, V. Tavoletta, A. D’Onofrio, V. M. Caso, G. Pedrizzetti, P. Caso

Published in: Journal of Medical Case Reports | Issue 1/2019

Abstract

Background

There are still many pendent issues about the effective evaluation of cardiac resynchronization therapy impact on functional mitral regurgitation. In order to reduce the intrinsic difficulties of quantification of functional mitral regurgitation itself, an automatic quantification of real-time three-dimensional full-volume color Doppler transthoracic echocardiography was proposed as a new, rapid, and accurate method for the assessment of functional mitral regurgitation severity. Recent studies suggested that images of left ventricle flow by echo-particle imaging velocimetry could be a useful marker of synchrony. 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.

Case summary

We describe a case in which the two technologies are used in combination during acute echocardiographic optimization of left pacing vector in a 63-year-old man, Caucasian, who showed worsening heart failure symptoms a few days after an implant, and the effect of the device’s optimization at 6-month follow-up.

Discussion

The degree of realignment of hemodynamic forces, with quantitative analysis of the orientation of blood flow momentum (φ), can represent improvement of fluid dynamics synchrony of the left ventricle, and explain, with a new deterministic parameter, the effects of cardiac resynchronization therapy on functional mitral regurgitation. Real-time three-dimensional color flow Doppler quantification is feasible and accurate for measurement of mitral inflow, left ventricular outflow stroke volumes, and functional mitral regurgitation severity.

Conclusion

This clinical case offers an innovative and accurate approach for acute echocardiographic optimization of left pacing vector. It shows clinical utility of combined three-dimensional full-volume color Doppler transthoracic echocardiography/echo-particle imaging velocimetry assessment to increase response to cardiac resynchronization therapy, in terms of reduction of functional mitral regurgitation, improving fluid dynamics synchrony of the left ventricle.

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Title: Combined flow-based imaging assessment of optimal cardiac resynchronization therapy pacing vector: a case report
Authors: A. R. Martiniello
V. Bianchi
G. Tonti
C. Cioppa
V. Tavoletta
A. D’Onofrio
V. M. Caso
G. Pedrizzetti
P. Caso
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Transthoracic Echocardiography
Echocardiography
Echocardiography
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Published in: Journal of Medical Case Reports / Issue 1/2019
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-019-2048-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Combined flow-based imaging assessment of optimal cardiac resynchronization therapy pacing vector: a case report

Abstract

Background

Case summary

Discussion

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case summary

Discussion

Conclusion

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