| Invasive acute hemodynamic response to guide left ventricular lead implantation predicts chronic remodeling in patients undergoing cardiac resynchronization therapy. | |
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MedLine Citation:
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PMID: 21884950 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We evaluated the relationship between acute hemodynamic response (AHR) and reverse remodeling (RR) in cardiac resynchronization therapy (CRT). BACKGROUND: CRT reduces mortality and morbidity in heart failure patients; however, up to 30% of patients do not derive symptomatic benefit. Higher proportions do not remodel. Multicenter trials have shown echocardiographic techniques are poor at improving response rates. We hypothesized the degree of AHR at implant can predict which patients remodel. METHODS: Thirty-three patients undergoing CRT (21 dilated and 12 ischemic cardiomyopathy) were studied. Left ventricular (LV) volumes were assessed before and after CRT. The AHR (maximum rate of left ventricular pressure [LV-dP/dt(max)]) was assessed at implant with a pressure wire in the LV cavity. Largest percentage rise in LV-dP/dt(max) from baseline (atrial antibradycardia pacing or right ventricular pacing with atrial fibrillation) to dual-chamber pacing (DDD)-LV was used to determine optimal coronary sinus LV lead position. Reverse remodeling was defined as reduction in LV end systolic volume ≥15% at 6 months. RESULTS: The LV-dP/dt(max) increased significantly from baseline (801 ± 194 mm Hg/s to 924 ± 203 mm Hg/s, p < 0.001) with DDD-LV pacing for the optimal LV lead position. The LV end systolic volume decreased from 186 ± 68 ml to 157 ± 68 ml (p < 0.001). Eighteen (56%) patients exhibited RR. There was a significant relationship between percentage rise in LV-dP/dt(max) and RR for DDD-LV pacing (p < 0.001). A similar relationship for AHR and RR in dilated cardiomyopathy and ischemic cardiomyopathy (p = 0.01 and p = 0.006) was seen. CONCLUSIONS: Acute hemodynamic response to LV pacing is useful for predicting which patients are likely to remodel in response to CRT both for dilated cardiomyopathy and ischemic cardiomyopathy. Using AHR has the potential to guide LV lead positioning and improve response rates. |
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Authors:
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Simon G Duckett; Matthew Ginks; Anoop K Shetty; Julian Bostock; Jaswinder S Gill; Shoaib Hamid; Stam Kapetanakis; Eliane Cunliffe; Reza Razavi; Gerry Carr-White; C Aldo Rinaldi |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 58 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-09-02 Completed Date: 2011-10-24 Revised Date: 2012-04-30 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1128-36 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Imaging Sciences, The Rayne Institute, Kings College London, London, United Kingdom. simon.duckett@kcl.ac.uk. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Resynchronization Therapy* Cardiac Resynchronization Therapy Devices Cardiomyopathy, Dilated / surgery Female Heart Failure / surgery* Humans Male Middle Aged Prosthesis Implantation / methods* Treatment Outcome Ventricular Pressure* Ventricular Remodeling* |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2011 Sep 6;58(11):1137-9
[PMID:
21884951
]
J Am Coll Cardiol. 2012 Mar 27;59(13):1198; author reply 1198-9 [PMID: 22440222 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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