Advanced Speckle-Tracking Echocardiography Could Play a Crucial Role in the Diagnosis of Post-Implanted Cardiomyopathy Associated with a Leadless Pacemaker System

Figures

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  Figure 1. The presentation of the patients’ ECG before LP implantation—QRS duration 100 ms (A), after LP implantation with VVI pacing—QRS duration 160 ms (B), after CRT-P implantation with biventricular pacing—QRS duration 100 ms (C).

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  Figure 2. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B,C) measurements during the first HF exacerbation; the yellow arrow indicates the area characteristic for PICM RV deformation pattern: decreased longitudinal strain and myocardial work indexes in septal middle and apical segments of the LV; the white arrow indicates the excessive myocardial work of lateral wall segments; (B) the green chart indicates ineffective myocardial work of the anterior part of the intraventricular septum; (C) the green chart indicates excessive myocardial work of the lateral wall segments.

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  Figure 3. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B) measurements before LP implantation.

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  Figure 4. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B) measurements during the first HF exacerbation, after switching off VVI pacing.

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  Figure 5. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B,C) measurements during the second HF exacerbation; the yellow arrow indicates the area characteristic for PICM RV deformation pattern: decreased longitudinal strain and myocardial work indexes in septal middle and apical segments of the LV; the white arrow indicates the excessive myocardial work of lateral wall segments; (B) the green chart indicates ineffective myocardial work of the anterior part of the intraventricular septum; (C) the green chart indicates excessive myocardial work of the lateral wall segments.

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  Figure 6. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B,C) measurements after CRT-P implantation with a significant improvement in septal segmental strain and MWI values. (B,C) presents the significant improvement in myocardial work values for intraventricular (B) and lateral (C) segments.

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  Figure 7. The “Bull’s-eye” representation of longitudinal strain (A) and myocardial work index (B) measurements at 6-months follow-up.