(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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D. A. Kass Predicting cardiac resynchronization response by qrs duration: The long and short of it |