| Toward understanding response to cardiac resynchronization therapy: left ventricular dyssynchrony is only one of multiple mechanisms. | |
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MedLine Citation:
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PMID: 19004844 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: To date, most published echocardiographic methods have assessed left ventricular (LV) dyssynchrony (DYS) alone as a predictor for response to cardiac resynchronization therapy (CRT). We hypothesized that the response is instead dictated by multiple correctable factors. METHODS AND RESULTS: A total of 161 patients (66 +/- 10 years, EF 24 +/- 6%, QRS > 120 ms) were investigated pre- and post-CRT (median of 6 months). Reduction in NYHA Class >/=1 or LV reverse remodelling (end-systolic volume reduction >/= 10%) defined response. Four different pathological mechanisms were identified. Group1: LVDYS characterized by a pre-ejection septal flash (SF) (87 patients, 54%). Elimination of SF (77 of 87 patients) resulted in reverse remodelling in 100%. Group 2: short-AV delay (21 patients, 13%) resolution (19 of 21 patients) resulted in reverse remodelling in 16 of 19. Group 3: long-AV delay (16 patients, 10%) resolution (14 of 16 patients) resulted in NYHA Class reduction >/=1 in 11 with reverse remodelling in five patients. Group 4: exaggerated LV-RV interaction (15 patients, 9%) reduced post-CRT. All responded clinically with fall in pulmonary artery pressure (P = 0.003) but did not volume respond. Group 5: patients with none of the above correctable mechanisms (22 patients, 14%). None responded to CRT. CONCLUSION: CRT response is dictated by correction of multiple independent mechanisms of which LVDYS is only one. Long-axis DYS measurements alone failed to detect 40% of responders. |
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Authors:
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Chirine Parsai; Bart Bijnens; George Ross Sutherland; Aigul Baltabaeva; Piet Claus; Maciej Marciniak; Vince Paul; Mike Scheffer; Erwan Donal; Geneviève Derumeaux; Lisa Anderson |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2008-11-11 |
Journal Detail:
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Title: European heart journal Volume: 30 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-15 Completed Date: 2009-08-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 940-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, St George's Hospital, Blackshaw Road, SW17 0QT London, UK. chirineparsai@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Arrhythmias, Cardiac / physiopathology, therapy* Cardiac Pacing, Artificial* Cardiac Volume Echocardiography, Doppler, Color Female Heart Failure / physiopathology Humans Male Middle Aged Myocardial Contraction Prospective Studies Stroke Volume Ventricular Dysfunction, Left / physiopathology, therapy* Ventricular Remodeling |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 2009 Apr;30(8):885-6
[PMID:
19297382
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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