Value of baseline left lateral wall postsystolic displacement assessed by M-mode to predict reverse remodeling by cardiac resynchronization therapy
| Autor: | Giulio Boggian, Alessandro Capecchi, Luca Gabrieli, Elisabetta Petracci, Roberto Vandelli, Donato Mele, Biagio Sassone, Saverio Saccà |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Pacemaker Artificial medicine.medical_treatment Diastole Cardiac resynchronization therapy Socio-culturale QRS complex Ventricular Dysfunction Left Internal medicine Heart rate medicine Humans PR interval Aged Heart Failure Ejection fraction Ventricular Remodeling business.industry medicine.disease Echocardiography Heart failure Circulatory system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American journal of cardiology. 100(3) |
| ISSN: | 0002-9149 |
| Popis: | Although left ventricular (LV) dyssynchrony assessed by ultrasound is emerging as superior to QRS duration in predicting response to cardiac resynchronization therapy (CRT), the role of conventional echocardiographic parameters of dyssynchrony is still debated. Forty-eight patients with heart failure in New York Heart Association classes III to IV, LV ejection fractionor =35%, and QRS durationor =120 ms were studied. LV dyssynchrony was evaluated by M-mode as septal-to-posterior wall motion delay and left lateral wall postsystolic displacement (LWPSD). Interventricular dyssynchrony was defined as the difference between the LV and right ventricular preejection periods measured by standard Doppler. Reverse remodeling was defined as an LV end-systolic volume decreaseor =15% after 6 months of CRT. Thirty-one patients (65%) were considered responders to CRT. At baseline responders differed from nonresponders by having less severe New York Heart Association class (p = 0.006), lower percentage of ischemic cause (p = 0.006), longer PR interval (p = 0.013), shorter LV diastolic filling time corrected for heart rate (p = 0.005), and presence of LWPSD (p = 0.003). At multivariate analysis, predictors of CRT response were LWPSD (odds ratio [OR] 1.045, 95% confidence interval [CI] 1.001 to 1.091; p = 0.043), LV diastolic filling time corrected for heart rate (OR 0.855, 95% CI 0.744 to 0.981, p = 0.026), and nonischemic cause (OR 0.109, 95% CI 0.018 to 0.657, p = 0.016). In conclusion, preimplantation assessment of cardiac dyssynchrony based on M-mode LWPSD may predict LV reverse remodeling after CRT, especially in patients with nonischemic cause and shorter diastolic filling time. This suggests the potential role of baseline postsystolic mechanical phenomena in determining response to CRT independently of QRS duration. |
| Databáze: | OpenAIRE |
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