Ana Maria Daraban
The Catholic University of America
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European Journal of Echocardiography | 2016
Ivan Stankovic; Christian Prinz; Agnieszka Ciarka; Ana Maria Daraban; Martin Kotrc; Marit Aarones; Mariola Szulik; Stefan Winter; Ann Belmans; Aleksandar Neskovic; Tomasz Kukulski; Svend Aakhus; Rik Willems; Wolfgang Fehske; Martin Penicka; Lothar Faber; Jens-Uwe Voigt
AIMS Apical rocking (ApRock) and septal flash (SF) are often observed phenomena in asynchronously contracting ventricles. We investigated the relationship of visually assessed ApRock and SF, reverse remodelling, and long-term survival in cardiac resynchronization therapy (CRT) candidates. METHODS AND RESULTS A total of 1060 patients eligible for CRT underwent echocardiographic examinations before and 12 ± 6 months after device implantation. Three blinded physicians were asked to visually assess the presence of ApRock and SF before device implantation and also their correction by CRT 12 ± 6 months post-implantation. Patients with a left ventricular (LV) end-systolic volume decrease of ≥15% during the first year of follow-up were regarded as responders. Patients were followed for a median period of 46 months (interquartile range: 27-65 months) for the occurrence of death of any cause. If corrected by CRT, visually assessed ApRock and SF were associated with reverse remodelling with a sensitivity of 84 and 79%, specificity of 79 and 74%, and accuracy of 82 and 77%, respectively. ApRock (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.30-0.53, P < 0.0001) and SF (HR 0.45 [CI 0.34-0.61], P < 0.001) were independently associated with lower all-cause mortality after CRT and had an incremental value over clinical variables and QRS width for identifying CRT responders. Both the absence of ApRock/SF and unsuccessful correction of ApRock/SF despite CRT were associated with a high risk for non-response and an unfavourable long-term survival. CONCLUSION A specific LV mechanical dyssynchrony pattern, characterized by ApRock and SF, is associated with a more favourable long-term survival after CRT. Both parameters are also indicators of an effective therapy.
European Journal of Echocardiography | 2018
Ahmed S Beela; Serkan Ünlü; Jürgen Duchenne; Agnieszka Ciarka; Ana Maria Daraban; Martin Kotrc; Marit Aarones; M. Szulik; Stefan Winter; Martin Penicka; Aleksandar Neskovic; T. Kukulski; Svend Aakhus; Rik Willems; Wolfgang Fehske; Lothar Faber; Ivan Stankovic; Jens-Uwe Voigt
Aim To determine if incorporation of assessment of mechanical dyssynchrony could improve the prognostic value of patient selection based on current guidelines. Methods and results Echocardiography was performed in 1060 patients before and 12 ± 6 months after cardiac resynchronization therapy (CRT) implantation. Mechanical dyssynchrony, defined as the presence of apical rocking or septal flash was visually assessed at the baseline examination. Response was defined as ≥15% reduction in left ventricular end-systolic volume at follow-up. Patients were followed for a median of 59 months (interquartile range 37-86 months) for the occurrence of death of any cause. Applying the latest European guidelines retrospectively, 63.4% of the patients had been implanted with a Class I recommendation, 18.2% with Class IIa, 9.4% with Class IIb, and in 9% no clear therapy recommendation was present. Response rates were 65% in Class I, 50% in IIa, 38% in IIb patients, and 40% in patients without a clear guideline-based recommendation. Assessment of mechanical dyssynchrony improved response rates to 77% in Class I, 75% in IIa, 62% in IIb, and 69% in patients without a guideline-based recommendation. Non-significant difference in survival among guideline recommendation classes was found (Log-rank P = 0.2). Presence of mechanical dyssynchrony predicted long-term outcome better than guideline Classes I, IIa, IIb (Log-rank P < 0.0001, 0.006, 0.004, respectively) and in patients with no guideline recommendation (P = 0.02). Comparable results were observed using the latest American Guidelines. Conclusion Our data suggest that current guideline criteria for CRT candidate selection could be improved by incorporating assessment of mechanical asynchrony.
European Journal of Echocardiography | 2017
Ivan Stankovic; Ann Belmans; Christian Prinz; Agnieszka Ciarka; Ana Maria Daraban; Martin Kotrc; Marit Aarones; Mariola Szulik; Stefan Winter; Aleksandar Neskovic; Tomasz Kukulski; Svend Aakhus; Rik Willems; Wolfgang Fehske; Martin Penicka; Lothar Faber; Jens-Uwe Voigt
Aims Clinical experience indicates that limited or no reverse left ventricular (LV) remodelling may not necessarily imply non-response to cardiac resynchronization therapy (CRT). We investigated the association of the extent of LV remodelling, mechanical dyssynchrony, and survival in patients undergoing CRT. Methods and results In 356 CRT candidates, three blinded readers visually assessed the presence of mechanical dyssynchrony (either apical rocking and/or septal flash) before device implantation and also its correction by CRT 12 ± 3 months post-implantation. To assess LV reverse remodelling, end-systolic volumes (ESV) were measured at the same time points. Patients were divided into four subgroups: no LV remodelling (ESV change 0 ± 5%), mild LV reverse remodelling (ESV reduction 5-15%), significant LV reverse remodelling (ESV reduction ≥15%), and LV volume expansion (ESV increase ≥5%). Patients were followed for all-cause mortality during the median follow-up of 36 months. Patients with LV remodelling as in the above defined groups showed 58, 54, and 84% reduction in all-cause mortality compared to patients with volume expansion. In multivariable analysis, LVESV change remained independently associated with survival, with an 8% reduction in mortality for every 10% decrease in LVESV (P = 0.0039), but an optimal cut-off point could not be established. In comparison, patients with corrected mechanical dyssynchrony showed 71% reduction in all-cause mortality (P < 0.001). Conclusion Volumetric response assessed at 1-year after CRT is strongly associated with long-term mortality. However, an optimal cut-off cannot be established. The association of the correction of mechanical dyssynchrony with survival was stronger than that of any volumetric cut-off.
Journal of The American Society of Echocardiography | 2015
Konstantinos E. Farsalinos; Ana Maria Daraban; Serkan Ünlü; James D. Thomas; L. U. I. G. I. Badano; Jens-Uwe Voigt
Jacc-cardiovascular Imaging | 2015
Razvan O. Mada; Peter Lysyansky; Ana Maria Daraban; Jürgen Duchenne; Jens-Uwe Voigt
European Journal of Echocardiography | 2016
Serkan Ünlü; Konstantinos E. Farsalinos; Koen Ameloot; Ana Maria Daraban; Agnieszka Ciarka; Marion Delcroix; Jens-Uwe Voigt
Jacc-cardiovascular Imaging | 2017
Ivan Stankovic; Christian Prinz; Agnieszka Ciarka; Ana Maria Daraban; Yujing Mo; Marit Aarones; Mariola Szulik; Stefan Winter; Aleksandar Neskovic; Tomasz Kukulski; Svend Aakhus; Rik Willems; Wolfgang Fehske; Martin Penicka; Lothar Faber; Jens-Uwe Voigt
Catheterization and Cardiovascular Interventions | 2017
Efstathios Pagourelias; Ana Maria Daraban; Razvan O. Mada; Jürgen Duchenne; Oana Mirea; Bjorn Cools; Ruth Heying; Derize Boshoff; Jan Bogaert; Werner Budts; Marc Gewillig; Jens-Uwe Voigt
European Heart Journal Supplements | 2013
Ruta Jasaityte; Jan D'hooge; Lieven Herbots; Ana Maria Daraban; Frank Rademakers; Piet Claus
European Heart Journal Supplements | 2013
Ruta Jasaityte; Jan D'hooge; Lieven Herbots; Ana Maria Daraban; Frank Rademakers; Piet Claus