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(Circulation. 2000;101:2703.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay
From the Division of Cardiology, Department of Medicine (G.S.N., C.W.C., M.T., M.R.D., R.D.B., D.A.K.), Department of Biomedical Engineering (B.T.W., J.D., E.R.M., D.A.K.), and Department of Radiology (E.R.M.), The Johns Hopkins Medical Institutions, Baltimore, Md; and Guidant Corp, St Paul, Minn (A.K.).
Correspondence to David A. Kass, MD, Halsted 500, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail dkass{at}bme.jhu.edu
Background—VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony.
Methods and Results—Twenty-two DCM patients with conduction delay
were studied by cardiac catheterization with a
dual-sensor micromanometer to measure LV and aortic
pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced
isovolumetric (dP/dtmax) and ejection-phase (pulse
pressure, PP) systolic function by 35±21% and 16.4±11%,
respectively, and these changes correlated directly
(r=0.7, P=0.001).
%
dP/dtmax was weakly predicted by baseline QRS
(r=0.6, P<0.02), more strongly by
baseline dP/dtmax (r=0.7,
P=0.001), and best by bidiscriminate analysis
combining baseline dP/dtmax 
700 mm Hg/s and QRS
155 ms to predict %dP/dtmax 25% and %PP 10%
(P<0.0005, 
2), with no false-positives.
Benefit could not be predicted by %QRS. To test whether basal
mechanical dyssynchrony predicted responsiveness to LV pacing,
circumferential strains were determined at 
80 sites throughout the
LV by tagged MRI in 8 DCM patients and 7 additional control subjects.
Strain variance at time of maximal shortening indexed dyssynchrony,
averaging 28.0±7.1% in normal subjects versus 201.4±84.3% in DCM
patients (P=0.001). Mechanical dyssynchrony also
correlated directly with %dP/dtmax
(r=0.85, P=0.008).
Conclusions—These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dtmax provides an excellent tool to identify maximal responders.
Key Words: heart failure • bundle-branch block • pacing • magnetic resonance imaging • mechanics
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A. Auricchio, C. Stellbrink, C. Butter, S. Sack, J. Vogt, A. R. Misier, D. Bocker, M. Block, J. H. Kirkels, Pacing Therapies in Congestive Heart Failure (PATH, et al. Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2109 - 2116. [Abstract] [Full Text] [PDF]
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A. Achilli, M. Sassara, S. Ficili, D. Pontillo, P. Achilli, C. Alessi, S. De Spirito, R. Guerra, N. Patruno, and F. Serra Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and "narrow" QRS J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2117 - 2124. [Abstract] [Full Text] [PDF]
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D. A. Kass Predicting cardiac resynchronization response by qrs duration: The long and short of it J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2125 - 2127. [Full Text] [PDF]
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Y. Yu, A. Kramer, J. Spinelli, J. Ding, W. Hoersch, and A. Auricchio Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2788 - H2796. [Abstract] [Full Text] [PDF]
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O. P. Faris, F. J. Evans, A. J. Dick, V. K. Raman, D. B. Ennis, D. A. Kass, and E. R. McVeigh Endocardial versus epicardial electrical synchrony during LV free-wall pacing Am J Physiol Heart Circ Physiol, November 1, 2003; 285(5): H1864 - H1870. [Abstract] [Full Text] [PDF]
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O.-A. Breithardt, C. Stellbrink, L. Herbots, P. Claus, A. M. Sinha, B. Bijnens, P. Hanrath, and G. R. Sutherland Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block J. Am. Coll. Cardiol., August 6, 2003; 42(3): 486 - 494. [Abstract] [Full Text] [PDF]
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X. A. A. M. Verbeek, K. Vernooy, M. Peschar, R. N. M. Cornelussen, and F. W. Prinzen Intra-ventricular resynchronization for optimal left ventricular function during pacing in experimental left bundle branch block J. Am. Coll. Cardiol., August 6, 2003; 42(3): 558 - 567. [Abstract] [Full Text] [PDF]
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T. V. Salukhe, M. Y. Henein, and R. Sutton Pacing in heart failure: patient and pacing mode selection Eur. Heart J., June 1, 2003; 24(11): 977 - 986. [Full Text] [PDF]
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G. B. Perego, R. Chianca, M. Facchini, A. Frattola, E. Balla, S. Zucchi, S. Cavaglia, I. Vicini, M. Negretto, and G. Osculati Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: an acute hemodynamic study Eur J Heart Fail, June 1, 2003; 5(3): 305 - 313. [Abstract] [Full Text] [PDF]
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A. M. Dubin, J. A. Feinstein, V. M. Reddy, F. L. Hanley, G. F. Van Hare, and D. N. Rosenthal Electrical Resynchronization: A Novel Therapy for the Failing Right Ventricle Circulation, May 13, 2003; 107(18): 2287 - 2289. [Abstract] [Full Text] [PDF]
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B. Nowak, A. M. Sinha, W. M. Schaefer, K.-C. Koch, H.-J. Kaiser, P. Hanrath, U. Buell, and C. Stellbrink Cardiac resynchronization therapyhomogenizes myocardial glucosemetabolism and perfusion in dilatedcardiomyopathy and left bundle branch block J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1523 - 1528. [Abstract] [Full Text] [PDF]
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A. Duncan, D. Wait, D. Gibson, and J.-C. Daubert Left ventricular remodelling and haemodynamic effects of multisite biventricular pacing in patients with left ventricular systolic dysfunction and activation disturbances in sinus rhythm: sub-study of the MUSTIC (Multisite Stimulationin Cardiomyopathies) trial Eur. Heart J., March 1, 2003; 24(5): 430 - 441. [Abstract] [Full Text] [PDF]
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D. J. Bradley, E. A. Bradley, K. L. Baughman, R. D. Berger, H. Calkins, S. N. Goodman, D. A. Kass, and N. R. Powe Cardiac Resynchronization and Death From Progressive Heart Failure: A Meta-analysis of Randomized Controlled Trials JAMA, February 12, 2003; 289(6): 730 - 740. [Abstract] [Full Text] [PDF]
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C-M Yu, H Lin, Q Zhang, and J E Sanderson High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration Heart, January 1, 2003; 89(1): 54 - 60. [Abstract] [Full Text] [PDF]
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S. Cazeau, C. Alonso, G. Jauvert, A. Lazarus, and P. Ritter Cardiac resynchronization therapy Europace, January 1, 2003; 5(s1): S42 - S48. [Abstract] [Full Text] [PDF]
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C. Stellbrink and B. Nowak The importance of being synchronous: on the prognostic value of ventricular conduction delay in heart failure J. Am. Coll. Cardiol., December 4, 2002; 40(11): 2031 - 2033. [Full Text] [PDF]
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M. V. Pitzalis, M. Iacoviello, R. Romito, F. Massari, B. Rizzon, G. Luzzi, P. Guida, A. Andriani, F. Mastropasqua, and P. Rizzon Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1615 - 1622. [Abstract] [Full Text] [PDF]
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C. Leclercq, S. Walker, C. Linde, J. Clementy, A.J. Marshall, P. Ritter, P. Djiane, P. Mabo, T. Levy, F. Gadler, et al. Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation Eur. Heart J., November 2, 2002; 23(22): 1780 - 1787. [Abstract] [Full Text] [PDF]
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O. A. Breithardt, C. Stellbrink, A. P. Kramer, A. M. Sinha, A. Franke, R. Salo, B. Schiffgens, E. Huvelle, A. Auricchio, and PATH-CHF Study Group Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy J. Am. Coll. Cardiol., August 7, 2002; 40(3): 536 - 545. [Abstract] [Full Text] [PDF]
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M. Kawaguchi, T. Murabayashi, B. J. Fetics, G. S. Nelson, H. Samejima, E. Nevo, and D. A. Kass Quantitation of basal dyssynchrony and acute resynchronization from left or biventricular pacing by novel echo-contrast variability imaging J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2052 - 2058. [Abstract] [Full Text] [PDF]
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M. Santini and R. Ricci Biventricular pacing in patients with heart failure and intraventricular conduction delay: state of the art and perspectives. The European view Eur. Heart J., May 1, 2002; 23(9): 682 - 686. [Full Text] [PDF]
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A. Auricchio, J. Ding, J. C. Spinelli, A. P. Kramer, R. W. Salo, W. Hoersch, B. H. KenKnight, H. U. Klein, and for the PATH-CHF Study Group Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1163 - 1169. [Abstract] [Full Text] [PDF]
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D.A Kass Ventricular dyssynchrony and mechanisms of resynchronization therapy Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D23 - D30. [Abstract] [PDF]
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A Auricchio and H.U Klein Beyond expectations: a decade of positive results with cardiac resynchronization therapy for heart failure Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D95 - D101. [Abstract] [PDF]
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R.G Charles Cardiac resynchronization therapy: when and for whom? Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D117 - D121. [Abstract] [PDF]
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