Prognostic significance of persistent restrictive filling pattern after cardiac resynchronization therapy.

Autor: Yamamoto, Masayoshi, Seo, Yoshihiro, Ishizu, Tomoko, Kawamatsu, Naoto, Sato, Kimi, Sugano, Akinori, Atsumi, Akiko, Harimura, Yoshie, Machino-Ohtsuka, Tomoko, Sakamaki, Fumiko, Aonuma, Kazutaka
Zdroj: Journal of Echocardiography; Mar2015, Vol. 13 Issue 1, p20-26, 7p
Abstrakt: Background: Cardiac resynchronization therapy (CRT) may improve left ventricular (LV) diastolic dysfunction as well as systolic dysfunction. Diastolic dysfunction is a key for prognosis in patients with heart failure; therefore, we aimed to clarify the impact of CRT on diastolic function and prognosis. Methods: In 67 patients who underwent CRT, LV diastolic function was assessed by pulsed Doppler transmitral flow pattern at baseline and 1 week after CRT, and classified into restrictive filling pattern (RFP) and non-RFP groups. Volume responders were defined by reduction of LV end-systolic volume >15 % at 6 months after CRT. The clinical endpoint comprised death from any cause or unplanned hospitalization for a major cardiovascular event (MACE). Results: During the follow-up period (479 ± 252 days), 26 patients (38.8 %) had reached the endpoint of MACE. In Cox proportional hazard analyses, RFP at 1 week after CRT was associated with the endpoints independently of age and New York Heart Association (NYHA) class IV at baseline. Thirty (44.8 %) patients were identified as volume responders, who had better prognosis than non-responders. Patients were classified into 4 groups based on their filling pattern at 1 week after CRT and volume responses. The worst prognosis was observed in the RFP and non-responder group, and the best was observed in the non-RFP and responder group. For the remaining 2 groups with intermediate prognosis, the RFP and responder group showed poorer prognosis compared to the non-RFP and non-responder group. Conclusions: Persistent RFP after CRT may be a strong prognostic predictor, which should be treated with more intensive therapy to improve the prognosis of patients following CRT. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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