Electrical remodelling post cardiac resynchronization therapy in patients with ischemic and non-ischemic heart failure
| Autor: | Andrew D. McGavigan, John D. Horowitz, Anand N. Ganesan, C. Ajaero |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy 030204 cardiovascular system & hematology Intracardiac injection Cardiac Resynchronization Therapy Contractility Electrocardiography 03 medical and health sciences Oxygen Consumption 0302 clinical medicine Quality of life Heart Conduction System Internal medicine Humans Medicine Prospective Studies 030212 general & internal medicine Aged Heart Failure Ventricular Remodeling business.industry medicine.disease Echocardiography Heart failure Exercise Test Quality of Life Etiology Cardiology Female Implant Cardiology and Cardiovascular Medicine business Intrinsic QRS Duration |
| Zdroj: | Journal of Electrocardiology. 53:44-51 |
| ISSN: | 0022-0736 |
| DOI: | 10.1016/j.jelectrocard.2018.12.001 |
| Popis: | Background The beneficial effects of cardiac resynchronization therapy (CRT) in heart failure are largely considered to be due to improved mechanical contractility. The contributory role of electrical remodelling is less clear. We sought to evaluate the impact of electrical remodelling in these patients. Methods 33 patients with conventional indications for CRT and with ischemic (ICM) (n = 17) and non-ischemic (NICM) (n = 16) aetiologies for heart failure were prospectively recruited. Functional parameters of peak exercise oxygen consumption (VO2max) and Minnesota quality of life (QOL) score, echocardiographic measures of LV functions and parameters of electrical remodelling, e.g. intrinsic QRS duration (iQRSD), intracardiac conduction times of LV pacing to RV electrocardiogram (LVp-RVegm), were measured at CRT implant and after 6 months. Results Only two electrical parameters predicted functional or symptomatic improvement. LVp-RVegm reduction significantly correlated with improvement in VO2max (r = −0.42, p = 0.03 while reduction in iQRSD significantly correlated with improvement in QOL score (r = 0.39, p = 0.04). The extent of changes in LVp-RVegm and iQRSD was significantly greater in NICM than in ICM patients (p = 0.017 and p = 0.042 for heterogeneity). There was also significant differential impact on QOL score in the NICM relative to the ICM group (p = 0.003) but none with VO2max. On multivariate analysis, only non-ischemic aetiology was a significant determinant of reduction in iQRSD. Conclusion CRT induces potentially beneficial reduction in LVp-RVegm and iQRSD, which are seen selectively in NICM rather than ICM patients. The extent of improvement in these markers is associated with some functional and symptomatic measures of CRT efficacy. |
| Databáze: | OpenAIRE |
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