Document Detail


Mechanical dyssynchrony in advanced decompensated heart failure: relation to hemodynamic responses to intensive medical therapy.
MedLine Citation:
PMID:  18675219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with heart failure, the degree of intraventricular mechanical dyssynchrony (intra-VMD) at baseline may predict reversal of cardiac remodeling with cardiac resynchronization therapy (CRT). OBJECTIVE: The purpose of this study was to determine the prevalence and clinical significance of intra-VMD in patients admitted for advanced decompensated heart failure (ADHF). METHODS: We prospectively enrolled 50 patients with ADHF without previous CRT implantation who had been admitted to a specialized heart failure intensive care unit because of hemodynamic derangements. All patients underwent comprehensive echocardiographic evaluation within 12 hours of admission and after 48 hours from baseline evaluation after intensive medical therapy. Intra-VMD was assessed by the opposing wall time-to-peak myocardial velocity intervals in a four-segment model using color-tissue Doppler imaging. RESULTS: In our study cohort (mean age 57 +/- 11 years, left ventricular ejection fraction 26 +/- 10%, QRS width 127 +/- 31 ms, cardiac index 2.0 +/- 0.6 L/min/m(2)), significant intra-VMD (>or=65 ms) was present in 44% of subjects at baseline, and 56% of patients presented with QRS >120 ms. There was no correlation between QRS width and extent of intra-VMD. Intensive medical therapy was associated with a significant reduction in intra-VMD (85 +/- 23 ms vs. 39 +/- 19 ms; P <.001). Significant hemodynamic improvement in cardiac index, filling pressures, and systemic and pulmonic vascular resistance was seen only in patients with intra-VMD. CONCLUSION: A substantial subset of patients admitted with ADHF and hemodynamic derangements demonstrate evidence of intra-VMD, which is reduced at follow-up and independent of underlying QRS width. Nevertheless, the presence of significant intra-VMD is associated with a more reversible hemodynamic profile.
Authors:
Wilfried Mullens; Allen G Borowski; Ronan Curtin; Richard A Grimm; James D Thomas; W H Wilson Tang
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-04-11
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-04     Completed Date:  2008-12-15     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1105-10     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Cardiac Pacing, Artificial*
Echocardiography, Doppler, Color
Exercise Tolerance
Female
Heart Failure / physiopathology*,  therapy*,  ultrasonography
Hemodynamics / drug effects*
Humans
Male
Middle Aged
Prevalence
Prospective Studies
Stroke Volume
Treatment Outcome
Ventricular Function, Left
Grant Support
ID/Acronym/Agency:
M01 RR018390/RR/NCRR NIH HHS

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


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