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on February 9, 2004

Circulation. 2004
Published online before print February 9, 2004, doi: 10.1161/01.CIR.0000116765.43251.D7
A more recent version of this article appeared on March 2, 2004
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Submitted on October 10, 2002
Revised on November 18, 2003
Accepted on November 18, 2003

Improvement of Left Ventricular Function After Cardiac Resynchronization Therapy Is Predicted by Tissue Doppler Imaging Echocardiography

Martin Penicka MD, Jozef Bartunek MD, PhD, Bernard De Bruyne MD, PhD, Marc Vanderheyden MD, Marc Goethals MD, Marc De Zutter RN, Pedro Brugada MD, PhD, and Peter Geelen MD, PhD*

From Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.

* To whom correspondence should be addressed. E-mail: peter.geelen{at}olvz-aalst.be.

Background--Cardiac resynchronization therapy was shown to reverse left ventricular (LV) remodeling in patients with congestive heart failure (CHF). However, the prediction of benefit is controversial. We aimed to investigate predictive factors of LV functional recovery and reversed remodeling after biventricular pacing.

Methods and Results--Forty-nine consecutive patients with CHF and a wide QRS complex (182±32 ms) were studied by echocardiography before resynchronization. Intraventricular and interventricular asynchrony and their combination were assessed by pulsed-wave tissue Doppler imaging from measurements of regional electromechanical coupling times in basal segments of the right and left ventricle. At 6-month follow-up, responders were defined by a relative increase in LV ejection fraction >=25% compared with baseline (n=27). Receiver operating curve analysis revealed the degree of intraventricular asynchrony (area under the curve=0.77), interventricular asynchrony (area under the curve=0.69), and their combination (area under the curve=0.84) as the best predictors of functional recovery after resynchronization. In addition, the degree of intraventricular and interventricular asynchrony correlated significantly with the improvement of LV ejection fraction (r=0.73, P<0.0001), end-diastolic diameter (r=-0.59, P<0.0001), and end-systolic diameter (r=-0.48, P<0.001) at follow-up. QRS duration and conventional echo-Doppler indices were not predictive of reversed LV remodeling.

Conclusions--In patients with CHF, the degree of intraventricular and interventricular asynchrony and their combination are the best predictive factors of LV functional recovery and reversed remodeling after cardiac resynchronization therapy.
Key words: pacing • heart failure • imaging • remodeling




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C M Yu, J J Bax, M Monaghan, and P Nihoyannopoulos
Echocardiographic evaluation of cardiac dyssynchrony for predicting a favourable response to cardiac resynchronisation therapy
Heart, December 1, 2004; 90(suppl_6): vi17 - vi22.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
A. Achilli, M. Sassara, D. Pontillo, N. Patruno, and P. Achilli
Reply
J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2096 - 2097.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
J. J. Bax, G. B. Bleeker, T. H. Marwick, S. G. Molhoek, E. Boersma, P. Steendijk, E. E. van der Wall, and M. J. Schalij
Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy
J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1834 - 1840.
[Abstract] [Full Text] [PDF]

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 Eur Heart J SupplHome page
B. Pieske
Reverse remodeling in heart failure - fact or fiction?
Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D66 - D78.
[Abstract] [Full Text] [PDF]


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