| Usefulness of left ventricle dyssynchrony assessment before cardiac resynchronization implantation. | |
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MedLine Citation:
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PMID: 20445710 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A number of trials have demonstrated the effect of cardiac resynchronization therapy (CRT) on functional improvement and reversed left ventricle remodeling. Meeting contemporary guidelines approximately 30- 40% of patients do not respond to CRT (non-responders). AIM: To quantify the predictive ability of basal QRS width and basal echocardiographic parameters of left ventricle contraction dyssynchrony in our group of CRT patients. To compare effectiveness of these parameters assessment in patients with ischemic (iCMP) and non-ischemic cardiomyopathy (niCMP) and with sinus rhythm (SR) and atrial fibrillation (AF). PATIENTS AND METHODS: 194 patients after successful introduction of CRT device were evaluated. Evaluation of NYHA function class, QRS width and echocardiographic parameters including parameters of left ventricle contraction dyssynchrony (SPWMD: septal-to-posterior wall motion delay, Ts-sep-lat: time interval between maximum of systolic movement of septum and lateral wall using tissue Doppler imaging, IVMD: interventricular mechanical delay) performed before implantation and 3 months after implantation of CRT device. RESULTS: Responder (improved in NYHA class after CRT) rate was 61%. SR patients showed higher benefit compared to AF patients (responder rate 63% vs. 52%, p<0.05). Narrowing of QRS width after CRT was observed only in responders. SPWMD and Ts-sep-lat decreased after CRT in all subgroups. SPWMD dyssynchrony (SPMWD > or = 130 ms) reduction after CRT was more expressed in niCMP population. Ts-sep-lat dyssynchrony (Ts-sep-lat > or = 65 ms) reduction after CRT was more expressed in SR patients. IVMD (IVMD > or = 60 ms) remained unchanged in average, but significant decrease was observed in responders and significant increase in non-responders. QRS width, SPWMD and Ts-sep-lat showed moderate sensitivity but poor specificity to predict CRT benefit. QRS width > or = 150 ms in niCMP patients showed higher sensitivity to predict CRT effect compared to iCMP patients (91%, 65% respectively). IVMD showed poor sensitivity but good specificity to predict CRT benefit. IVMD in SR patients (compared to AF patients) showed higher specificity to predict CRT effect (90%, 63% respectively). CONCLUSION: None of tested left ventricle contraction dyssynchrony parameters showed good sensitivity and specificity to predict CRT benefit. QRS width as a predictor factor was more beneficial in non-ischemic patients and IVMD in sinus rhythm patients. |
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Authors:
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Jolana Lipoldova; Eva Ozabalova; Jaroslav Meluzin; Miroslav Novak; Jiri Vitovec |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia Volume: 154 ISSN: 1213-8118 ISO Abbreviation: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-05-06 Completed Date: 2010-08-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101140142 Medline TA: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Country: Czech Republic |
Other Details:
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Languages: eng Pagination: 39-46 Citation Subset: IM |
Affiliation:
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1st Internal Clinic of Cardiology and Angiology, St. Anne's Faculty Hospital, Masaryk University, Brno. jolana.lipoldova@fnusa.cz |
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Fibrillation
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complications Cardiac Pacing, Artificial* Cardiomyopathies / complications, physiopathology*, therapy Defibrillators, Implantable* Echocardiography* Electrocardiography* Humans Myocardial Contraction Predictive Value of Tests Sensitivity and Specificity Stroke Volume Ventricular Dysfunction, Left / physiopathology, therapy* Ventricular Remodeling |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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