Document Detail


Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy.
MedLine Citation:
PMID:  18987095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Cardiac resynchronization therapy (CRT) improves functional capacity and survival in heart failure. However, one-third of patients fail to respond to CRT. Resting left ventricular (LV) dyssynchrony assessed by echocardiography (ECHO) showed discordant results in identifying CRT responders. LV dyssynchrony can totally change during exercise. Aim of this study was to evaluate whether exercise dyssynchrony could select responders to CRT. METHODS AND RESULTS: Sixty-four patients scheduled for CRT implantation performed bicycle exercise ECHO in semi-supine position on an exercise tilting table before and 6 months after CRT implantation. Tissue Doppler imaging (TDI) was acquired both at rest and during exercise to detect LV mechanical dyssynchrony. Predictive values for CRT response were 70% for rest TDI and 89% for exercise TDI (P = 0.01). Exercise LV dyssynchrony was the only parameter independently associated with follow-up improvement of rest ejection fraction and LV volume during multivariable analysis (P < 0.001). Functional improvement at 6-min walking test was statistically higher in patients with exercise dyssynchrony (P = 0.005), and not different considering rest dyssynchrony (P = 0.30). CONCLUSION: Exercise intraventricular dyssynchrony assessed by exercise TDI ECHO is a strong independent predictor of CRT response. It could be used to select candidates for CRT, thus reducing ineffective implantations of biventricular pacemakers.
Authors:
Guido Rocchi; Matteo Bertini; Mauro Biffi; Matteo Ziacchi; Elena Biagini; Ilaria Gallelli; Cristian Martignani; Elena Cervi; Marinella Ferlito; Claudio Rapezzi; Angelo Branzi; Giuseppe Boriani
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-11-05
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-02     Completed Date:  2009-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  89-97     Citation Subset:  IM    
Affiliation:
Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. guidorocchi@libero.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial
Cardiomyopathy, Dilated / diagnosis*,  physiopathology,  therapy
Echocardiography, Doppler, Pulsed
Echocardiography, Stress*
Exercise Test*
Female
Follow-Up Studies
Humans
Logistic Models
Male
Middle Aged
Patient Selection*
Prospective Studies
Sensitivity and Specificity
Ventricular Remodeling*

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


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