CONTINUING MEDICAL EDUCATION

CME Test for Right Ventricular Apical Pacing Impairs Left Ventricular Twist as Well asSynchrony: Acute Effects of Right Ventricular Apical Pacing

Volume 22 � Issue 8

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After reading Right Ventricular Apical Pacing Impairs Left VentricularTwist as Well as Synchrony: Acute Effects of Right Ventricular ApicalPacing please respond to the following questions.

EXAM

1. Which of the following effects of right ventricularapical pacing have not been previously been described inhumans?

a. Reduced left ventricular ejection fraction.b. Asynchronous contraction of the left ventricular septal and

lateral walls.c. Increased incidence of symptomatic heart failure.d. Reduced left ventricular twist.

2. Which of the following statements is true regarding themethods used to measure left ventricular dyssynchrony?

a. Color-coded tissue Doppler imaging was acquired from para-sternal views to measure both longitudinal and radial dyssyn-chrony.

b. Sample volumes were placed in the basal portions of the sep-tum and lateral walls to measure longitudinal dyssynchrony.

c. The time from QRS to first negative diastolic velocity wasmeasured and compared between segments.

d. Radial dyssynchrony was defined as the difference betweenthe earliest and latest times to peak negative strain.

3. Which of the following statements is true regarding leftventricular rotation?

a. Apical (no visible papillary muscle) and basal (at the level ofthe mitral valve) short-axis views were obtained using lowframe rates.

b. Net apical rotation is normally clockwise.c. Net basal rotation is normally counterclockwise.d. Speckle tracking imaging was used to calculate rotation at

each level of the ventricle.

4. Which of the following is false:a. Left ventricular twist (in degrees) was calculated as the net

difference between left ventricular apical and basal rotationduring systole.

b. Left ventricular untwist velocity (in cm/s) was calculated asa measure of left ventricular relaxation.

c. Twist and time to peak rotation measurements have highintraobserver variability.

d. Dyssynchrony was measured as the difference in time topeak rotation between the apex and base.

5. Which of the following occur when changing from intrin-sic atrioventricular conduction to right ventricular pacing?

a. The left ventricular ejection fraction is reduced.b. LV longitudinal dyssynchrony lengthens.c. LV radial dyssynchrony lengthens.d. All of the above.

6. As a result of RV pacing, which of the following occurs?a. Peak rotation in the apex is reduced; peak rotation of the base

is reduced with a reduction in twist.b. Peak rotation in the apex is increased; peak rotation of the

base is increased with an increase in twist.c. Peak rotation in the apex is reduced; peak rotation of the base

is increased with no change in twist.d. Peak rotation in the apex is reduced; peak rotation of the base

is reduced with no change in twist.

7. As a result of RV pacing, which of the following occurs?a. Time to peak rotation (Q-peak) in the apex is reduced;

Q-peak rotation of the base is reduced with no change inapical-basal delay.

b. Q-peak rotation in the apex is increased, Q-peak rotation ofthe base is reduced with an increase in apical-basal delay.

c. Q-peak rotation in the apex is unchanged, Q-peak rotation ofthe base is reduced with an increase in apical-basal delay.

d. Q-peak rotation in the apex is unchanged; Q-peak rotation ofthe base is unchanged with no change in apical-basal delay.

8. Which of the following parameters correlates signifi-cantly with longitudinal and radial dyssynchrony?

a. LV twistb. LV untwist velocityc. Basal Q-peak rotationd. Apical-basal rotation delaye. All of the above

9. In the current study, left ventricular twist correlated withthe reduction in ejection fraction.

a. Trueb. False

10. Changes in left ventricular twist with right ventricularapical pacing may help target heart failure patients in needof resynchronization therapy.

a. Trueb. False

Journal of the American Society of EchocardiographyVolume 22 Number 8

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