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Povzetek: Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.
Ključne besede: cardiac magnetic resonance, cardiomyopathy, myocardial function, myocardial work, speckle-tracking echocardiography, strain
Objavljeno v DiRROS: 08.01.2026; Ogledov: 705; Prenosov: 566
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Povzetek: Aims: There are limited prospective randomized studies comparing left bundle branch area pacing (LBBAP) and biventricular (BiV) pacing for cardiac resynchronization therapy (CRT). The study tested whether LBBAP is non-inferior to BiV pacing in patients with Class I indication for CRT. Methods and results: The CSP-SYNC study is an investigator-initiated, randomized, single-centre study. Sixty-two patients were randomized 1:1 to LBBAP or BiV. The primary study endpoint was the change in left ventricular ejection fraction (LVEF) at 6 months. Secondary endpoints included changes in echo and clinical parameters after 6 months and 12 months. Thirty-one patients were randomized to each arm. Most patients were males (71%), and 32% had ischaemic cardiomyopathy. At 6 months, similar improvement of LVEF was observed in the LBBAP group compared to the BiV group [14.0% (95% confidence interval (CI): 11.2–16.8) in LBBAP vs. 8.5% (95% CI: 5.6–11.2) in BiV] with a mean intergroup difference of 5.6% (95% CI: 1.6–9.5; P < 0.001 for non-inferiority). Both groups showed comparable decrease in LVESV [−64 mL (95% CI: −78 to −50) vs. −40 mL (95% CI: −54 to −25) respectively, mean difference −24 mL (CI 95%: −44 to −4); P < 0.001 for non-inferiority] and changes in 6-min walk test (P < 0.001 for non-inferiority) and NYHA class (P = 0.011 for non-inferiority). Temporal trends of LV remodelling and heart failure hospitalization rates were also comparable. Conclusion: In patients with a Class I indication for CRT, LBBAP was non-inferior to BiV pacing in improving LVEF and provided similar structural and electrical remodelling.
Ključne besede: cardiac resynchronization therapy, biventricular pacing, left bundle branch area pacing, left bundle branch block, conduction system pacing
Objavljeno v DiRROS: 05.01.2026; Ogledov: 390; Prenosov: 140
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