Document Detail


Clinical and prognostic role of pressure-volume relationship in the identification of responders to cardiac resynchronization therapy.
MedLine Citation:
PMID:  21095279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The identification of responders remains challenging in cardiac resynchronization therapy (CRT). Pressure-volume relationship (PVR) is a method to evaluate left ventricular myocardial contractility during stress. The aim of the study was to assess the role of PVR to identify responders to CRT.
METHODS: Seventy-two patients (57% with ischemic etiology) referred to CRT: ejection fraction ≤ 35%, New York Heart Association ≥ III and QRS duration ≥ 120 milliseconds, underwent dobutamine stress echocardiography (up to 40 μg/kg per minute). PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dobutamine stress echocardiography. Responders were identified by clinical and/or echocardiographic (end-systolic volume decrease ≥ 15%) follow-up criteria. We divided retrospectively the patient population into 2 groups, accordingly to the presence of myocardial contractile reserve that was set at the value of PVR (0.72 mm Hg/mL per square meter) obtained by a receiver operating characteristic analysis.
RESULTS: During a median follow-up of 12 months, 8 patients (11%) died. Patients with lower PVR, showed higher brain natriuretic peptide levels (853 ± 1211 vs 342 ± 239, P = .044) larger left ventricular end-diastolic (196 ± 82 mL vs 152 ± 39 mL, P = .005) and end-systolic (147 ± 66 vs 112 ± 30 mL, P = .006) volumes. Intraventricular dyssynchrony was similar in the 2 groups (88 ± 45 vs 70 ± 32 milliseconds, P = .175). Patients with higher PVR presented a larger incidence of clinical (86% vs 46% P < .001), and echocardiographic responders to CRT (79% vs 40%, P = .002). Event-free survival was significantly better in patients with higher PVR (log rank = 5.78, P = .01).
CONCLUSION: Patients with preserved contractility, assessed by PVR during stress echocardiography show a favor clinical outcome and left ventricular reverse remodeling after CRT. In particular, PVR may have a significant clinical role in patients undergoing CRT, providing critical information for risk stratification.
Authors:
Quirino Ciampi; Lorenza Pratali; Rodolfo Citro; Bruno Villari; Eugenio Picano; Rosa Sicari
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  906-14     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Affiliation:
Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy. qciampi@iol.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Resynchronization Therapy / methods*
Cardiac Volume / physiology*
Echocardiography, Stress
Female
Follow-Up Studies
Heart Failure / diagnosis,  physiopathology,  therapy*
Humans
Male
Myocardial Contraction
Prognosis
Prospective Studies
ROC Curve
Treatment Outcome
Ventricular Pressure / physiology*
Ventricular Remodeling / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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