Author
Etelvino Silva
Other affiliations: Autonomous University of Barcelona
Bio: Etelvino Silva is an academic researcher from University of Barcelona. The author has contributed to research in topics: Cardiac resynchronization therapy & QRS complex. The author has an hindex of 15, co-authored 38 publications receiving 993 citations. Previous affiliations of Etelvino Silva include Autonomous University of Barcelona.
Papers
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TL;DR: In this article, a 3D reconstruction of the ce-CMR could allow visualization of the 3D structure of these BZ channels, more commonly seen in the endocardium, which can be used to guide ventricular tachycardia (VT) ablation.
Abstract: Background— Conducting channels are the target for ventricular tachycardia (VT) ablation. Conducting channels could be identified with contrast enhanced–cardiac magnetic resonance (ce-CMR) as border zone (BZ) corridors. A 3-dimensional (3D) reconstruction of the ce-CMR could allow visualization of the 3D structure of these BZ channels.
Methods and Results— We included 21 patients with healed myocardial infarction and VT. A 3D high-resolution 3T ce-CMR was performed before CARTO-guided VT ablation. The left ventricular wall was segmented and characterized using a pixel signal intensity algorithm at 5 layers (endocardium, 25%, 50%, 75%, epicardium). A 3D color-coded shell map was obtained for each layer to depict the scar core and BZ distribution. The presence/characteristics of BZ channels were registered for each layer. Scar area decreased progressively from endocardium to epicardium (scar area/left ventricular area: 34.0±17.4% at endocardium, 24.1±14.7% at 25%, 16.3±12.1% at 50%, 13.1±10.4 at 75%, 12.1±9.3% at epicardium; P <0.01). Forty-five BZ channels (2.1±1.0 per patient, 23.7±12.0 mm length, mean minimum width 2.5±1.5 mm) were identified, 85% between the endocardium and 50% shell and 76% present in ≥1 layer. The ce-CMR–defined BZ channels identified 74% of the critical isthmus of clinical VTs and 50% of all the conducting channels identified in electroanatomic maps.
Conclusions— Scar area in patients with healed myocardial infarction decreases from the endocardium to the epicardium. BZ channels, more commonly seen in the endocardium, display a 3D structure within the myocardial wall that can be depicted with ce-CMR. The use of ce-CMR–derived maps to guide VT ablation warrants further investigation.
170 citations
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TL;DR: TDFFD was applied to a database of cardiac 3D US images of the left ventricle acquired from 9 healthy volunteers and 13 patients treated by Cardiac Resynchronization Therapy (CRT), showing the potential of the proposed algorithm for the assessment of CRT.
164 citations
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TL;DR: Scar characterization by means of high resolution CE-CMR resembles that of EAM and can be integrated into the CARTO system to guide ventricular tachycardia (VT) ablation.
Abstract: Background— Scar heterogeneity identified with contrast-enhanced cardiac magnetic resonance (CE-CMR) has been related to its arrhythmogenic potential by using different algorithms The purpose of the study was to identify the algorithm that best fits with the electroanatomic voltage maps (EAM) to guide ventricular tachycardia (VT) ablation
Methods and Results— Three-dimensional scar reconstructions from preprocedural CE-CMR study at 3T were obtained and compared with EAMs of 10 ischemic patients submitted for a VT ablation Three-dimensional scar reconstructions were created for the core (3D-CORE) and border zone (3D-BZ), applying cutoff values of 50%, 60%, and 70% of the maximum pixel signal intensity to discriminate between core and BZ The left ventricular cavity from CE-CMR (3D-LV) was merged with the EAM, and the 3D-CORE and 3D-BZ were compared with the corresponding EAM areas defined with standard cutoff voltage values The best match was obtained when a cutoff value of 60% of the maximum pixel signal intensity was used, both for core ( r 2=0827; P <0001) and BZ ( r 2=0511; P =0020), identifying 69% of conducting channels (CC) observed in the EAM Matching improved when only the subendocardial half of the wall was segmented (CORE: r 2=0808; P <0001 and BZ: r 2=0485; P =0025), identifying 81% of CC When comparing the location of each bipolar voltage intracardiac electrogram with respect to the 3D CE-CMR–derived structures, a Cohen κ coefficient of 070 was obtained
Conclusions— Scar characterization by means of high resolution CE-CMR resembles that of EAM and can be integrated into the CARTO system to guide VT ablation
157 citations
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TL;DR: A new method for the automatic comparison of myocardial motion patterns and the characterization of their degree of abnormality, based on a statistical atlas of motion built from a reference healthy population is presented.
75 citations
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TL;DR: The presence, size, and heterogeneity of myocardial scar independently predict appropriate ICD therapies in CRT candidates and might help identify a subgroup of patients at relatively low risk of SCD.
Abstract: Aims There is insufficient evidence to implant a combined cardiac resynchronization therapy (CRT) device with defibrillation capabilities (CRT-D) in all CRT candidates. The aim of the study was to assess myocardial scar size and its heterogeneity as predictors of sudden cardiac death (SCD) in CRT candidates.
Methods and results A cohort of 78 consecutive patients with dilated cardiomyopathy and class I indication for CRT-D were prospectively enrolled. Before CRT-D implantation, a contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed. The core and border zone (BZ) of the myocardial scar were characterized and quantified with a customized post-processing software. The first appropriate implantable cardioverter defibrillator (ICD) therapy was considered as a surrogate of SCD. During a mean follow-up of 25 months (25–75th percentiles, 15–34), appropriate ICD therapy occurred in 11.5% of patients. In a multivariate Cox proportional hazards regression model for clinical and ce-CMR variables, the scar mass percentage [hazards ratio (HR) per 1% increase 1.1 (1.06–1.15), P < 0.01], the BZ mass [HR per 1 g increase 1.06 (1.04–1.09), P < 0.01], and the BZ percentage of the scar [HR per 1% increase 1.06 (1.02–1.11), P < 0.01], were the only independent predictors of appropriate ICD therapy. Receiver-operating characteristic curve analysis showed that a scar mass <16% and a BZ < 9.5 g had a negative predictive value of 100%.
Conclusions The presence, size, and heterogeneity of myocardial scar independently predict appropriate ICD therapies in CRT candidates. The ce-CMR-based scar analysis might help identify a subgroup of patients at relatively low risk of SCD.
72 citations
Cited by
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TL;DR: The objective of this study was to establish a baseline level of confidence that the once-in-a-lifetime implantation trial—Reduce Inappropriate Therapy protocol can be trusted to provide safe and effective treatment for cardiac arrhythmia and stroke-like episodes.
Abstract: 2D
: two-dimensional
99mTc-DPD
: 99mTechnetium-3,3-diphosphono- 1,2-propanodi-carboxylic acid
ACE
: angiotensin-converting enzyme
AF
: atrial fibrillation
AL
: amyloid light chain
AR
: aortic regurgitation
ARB
: angiotensin receptor blocker
ATTR
: amyloidosis-transthyretin type
AV
: atrioventricular
BiVAD
: biventricular assist device
BNP
: brain natriuretic peptide
BPM
: Beats per minute
CCS
: Canadian Cardiovascular Society
CFC
: cardiofacialcutaneous
CHA2DS2-VASc
: Congestive Heart failure, hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, and Sex (female)
CMR
: cardiac magnetic resonance
CRT
: cardiac resynchronization therapy
CRT-D
: cardiac resynchronization therapy-defibrillator
CRT-P
: Cardiac resynchronization therapy with a pacemaker
CT
: computed tomography
DC
: direct current
DNA
: deoxyribonucleic acid
E/A
: ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A)
E/e’
: ratio of early transmitral flow velocity (E) to early mitral annulus velocity (e’)
EACTS
: European Association for Cardio-Thoracic Surgery
ECG
: electrocardiogram
EF
: ejection fraction
EPS
: electrophysiological study
ESC
: European Society of Cardiology
FDA
: (US) Food and Drug Administration
FHL1
: four and a half LIM domains 1
HAS-BLED
: hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly (>65 years), drugs/alcohol concomitantly
HCM
: hypertrophic cardiomyopathy
hs-cTnT
: high sensitivity cardiac troponin T
HTS
: high throughput sequencing
ICD
: implantable cardioverter defibrillator
ILR
: implantable loop recorder
INR
: international normalized ratio
IUD
: intrauterine device
LA
: left atrium
LAMP-2
: lysosome-associated membrane protein 2
LBBB
: left bundle branch block
LEOPARD
: Lentigines, ECG abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormal genitalia, Retardation of growth, and sensory-neural Deafness
LGE
: late gadolinium enhancement
LV
: left ventricular
LVAD
: left ventricular assist device
LVH
: left ventricular hypertrophy
LVOTO
: left ventricular outlow tract obstruction
MADIT-RIT
: Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy
MAPK
: mitogen activated protein kinase
MELAS
: mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
MERFF
: myoclonic epilepsy with ragged red fibres
MRA
: mineralocorticoid receptor antagonist
MYBPC3
: myosin-binding protein C, cardiac-type
MYH7
: myosin-7 (s-myosin heavy chain)
MYL3
: myosin light chain 3
NOAC
: new oral anticoagulants
NSVT
: non-sustained ventricular tachycardia
NT-proBNP
: N-terminal pro brain natriuretic peptide
NYHA
: New York Heart Association
OAC
: oral anticoagulants
o.d.
: omni die (every day)
PC-CMR
: phase contrast cardiac magnetic resonance
PDE5
: phosphodiesterase type 5
PET
: positron emission tomography
PRKAG2
: gamma-2 sub-unit of the adenosine monophosphate-activated protein kinase
RAAS
: renin angiotensin aldosterone system
RV
: right ventricular
SAM
: systolic anterior motion
SCD
: sudden cardiac death
SAA
: septal alcohol ablation
S-ICD™
: Subcutaneous lead implantable cardioverter defibrillator
SPECT
: single photon emission computed tomography
SSFP
: steady-state free precession
SVT
: supraventricular tachycardia
TOE
: transoesophageal echocardiography
TNNI3
: troponin I, cardiac muscle
TNNT2
: troponin T, cardiac muscle
TPM1
: tropomyosin alpha-1 chain
TTE
: transthoracic echocardiography
TTR
: transthyretin
VF
: ventricular fibrillation
VKA
: vitamin K antagonist
VT
: ventricular tachycardia
WHO
: World Health Organization
Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.
Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management (including diagnosis, treatment, prevention and rehabilitation) of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk-benefit-ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .
The experts of …
3,276 citations
•
[...]
TL;DR: 1. Place animal in induction chamber and anesthetize the mouse and ensure sedation, move it to a nose cone for hair removal using cream and reduce anesthesia to maintain proper heart rate.
Abstract: 1. Place animal in induction chamber and anesthetize the mouse and ensure sedation. 2. Once the animal is sedated, move it to a nose cone for hair removal using cream. Only apply cream to the area of the chest that will be utilized for imaging. Once the hair is removed, wipe area with wet gauze to ensure all hair is removed. 3. Move the animal to the imaging platform and tape its paws to the ECG lead plates and insert rectal probe. Body temperature should be maintained at 36-37°C. During imaging, reduce anesthesia to maintain proper heart rate. If the animal shows signs of being awake, use a higher concentration of anesthetic.
1,557 citations
••
TL;DR: 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure : implant and follow-up recommendations and management.
408 citations
••
346 citations
••
TL;DR: Authors/Task Force Members: Perry M. Elliott* (Chairperson), Aris Anastasakis (Greece), Michael A. Nihoyannopoulos (UK), Stefano Nistri (Italy), Petronella G. Pieper (Netherlands), Burkert Pieske (Austria), Claudio Rapezzi (Italy) and Christoph Tillmanns (Germany).
Abstract: 2D
: two-dimensional
99mTc-DPD
: 99mTechnetium-3,3-diphosphono- 1,2-propanodi-carboxylic acid
ACE
: angiotensin-converting enzyme
AF
: atrial fibrillation
AL
: amyloid light chain
AR
: aortic regurgitation
ARB
: angiotensin receptor blocker
ATTR
: amyloidosis-transthyretin type
AV
: atrioventricular
BiVAD
: biventricular assist device
BNP
: brain natriuretic peptide
BPM
: Beats per minute
CCS
: Canadian Cardiovascular Society
CFC
: cardiofacialcutaneous
CHA2DS2-VASc
: Congestive Heart failure, hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, and Sex (female)
CMR
: cardiac magnetic resonance
CRT
: cardiac resynchronization therapy
CRT-D
: cardiac resynchronization therapy-defibrillator
CRT-P
: Cardiac resynchronization therapy with a pacemaker
CT
: computed tomography
DC
: direct current
DNA
: deoxyribonucleic acid
E/A
: ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A)
E/e’
: ratio of early transmitral flow velocity (E) to early mitral annulus velocity (e’)
EACTS
: European Association for Cardio-Thoracic Surgery
ECG
: electrocardiogram
EF
: ejection fraction
EPS
: electrophysiological study
ESC
: European Society of Cardiology
FDA
: (US) Food and Drug Administration
FHL1
: four and a half LIM domains 1
HAS-BLED
: hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly (>65 years), drugs/alcohol concomitantly
HCM
: hypertrophic cardiomyopathy
hs-cTnT
: high sensitivity cardiac troponin T
HTS
: high throughput sequencing
ICD
: implantable cardioverter defibrillator
ILR
: implantable loop recorder
INR
: international normalized ratio
IUD
: intrauterine device
LA
: left atrium
LAMP-2
: lysosome-associated membrane protein 2
LBBB
: left bundle branch block
LEOPARD
: Lentigines, ECG abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormal genitalia, Retardation of growth, and sensory-neural Deafness
LGE
: late gadolinium enhancement
LV
: left ventricular
LVAD
: left ventricular assist device
LVH
: left ventricular hypertrophy
LVOTO
: left ventricular outlow tract obstruction
MADIT-RIT
: Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy
MAPK
: mitogen activated protein kinase
MELAS
: mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
MERFF
: myoclonic epilepsy with ragged red fibres
MRA
: mineralocorticoid receptor antagonist
MYBPC3
: myosin-binding protein C, cardiac-type
MYH7
: myosin-7 (s-myosin heavy chain)
MYL3
: myosin light chain 3
NOAC
: new oral anticoagulants
NSVT
: non-sustained ventricular tachycardia
NT-proBNP
: N-terminal pro brain natriuretic peptide
NYHA
: New York Heart Association
OAC
: oral anticoagulants
o.d.
: omni die (every day)
PC-CMR
: phase contrast cardiac magnetic resonance
PDE5
: phosphodiesterase type 5
PET
: positron emission tomography
PRKAG2
: gamma-2 sub-unit of the adenosine monophosphate-activated protein kinase
RAAS
: renin angiotensin aldosterone system
RV
: right ventricular
SAM
: systolic anterior motion
SCD
: sudden cardiac death
SAA
: septal alcohol ablation
S-ICD™
: Subcutaneous lead implantable cardioverter defibrillator
SPECT
: single photon emission computed tomography
SSFP
: steady-state free precession
SVT
: supraventricular tachycardia
TOE
: transoesophageal echocardiography
TNNI3
: troponin I, cardiac muscle
TNNT2
: troponin T, cardiac muscle
TPM1
: tropomyosin alpha-1 chain
TTE
: transthoracic echocardiography
TTR
: transthyretin
VF
: ventricular fibrillation
VKA
: vitamin K antagonist
VT
: ventricular tachycardia
WHO
: World Health Organization
Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.
Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management (including diagnosis, treatment, prevention and rehabilitation) of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk-benefit-ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .
The experts of …
339 citations