CLINICAL STUDY: CLINICAL APPLICATION OF ECHOCARDIOGRAPHIC FINDINGS
Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony
Maria Vittoria Pitzalis, MD, PhD*,*,
Massimo Iacoviello, MD*,
Roberta Romito, MD ,
Francesco Massari, MD,
Brian Rizzon, MD*,
Giovanni Luzzi, MD*,
Pietro Guida, MS*,
Andrea Andriani, MD*,
Filippo Mastropasqua, MD and
Paolo Rizzon, MD*
* Institute of Cardiology, University of Bari, Bari, Italy
Cardiology, "S. Maugeri" Foundation, IRCCS, Cassano Murge, Bari, Italy
Manuscript received January 28, 2002;
revised manuscript received April 9, 2002,
accepted June 24, 2002.
* Reprint requests and correspondence: Dr. Maria Vittoria Pitzalis, Institute of Cardiology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
mariavittoria.pitzalis{at}cardio.uniba.it
OBJECTIVES: The value of interventricular and intraventricular echocardiographic asynchrony parameters in predicting reverse remodeling after cardiac resynchronization therapy (CRT) was investigated.
BACKGROUND: Cardiac resynchronization therapy has been suggested as a promising strategy in patients with severe heart failure and left bundle branch block (LBBB), but the entity of benefit is variable and no criteria are yet available to predict which patients will gain.
METHODS: Interventricular and intraventricular mechanical asynchrony was evaluated in 20 patients (8 men and 12 women, 63 ± 10 years) with advanced heart failure caused by ischemic (n = 4) or nonischemic dilated cardiomyopathy (n = 16) and LBBB (QRS duration of at least 140 ms) using echocardiographic Doppler measurements. Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were calculated before and one month after CRT. Patients with a LVESVI reduction of at least 15% were considered as responders.
RESULTS: Cardiac resynchronization therapy significantly improved ventricular volumes (LVEDVI from 150 ± 53 ml/m2 to 119 ± 37 ml/m2, p < 0.001; LVESVI from 116 ± 43 ml/m2 to 85 ± 29 ml/m2, p < 0.0001). At baseline, the responders had a significantly longer septal-to-posterior wall motion delay (SPWMD), a left intraventricular asynchrony parameter; only QRS duration and SPWMD significantly correlated with a reduction in LVESVI (r = –0.54, p < 0.05 and r = –0.70, p < 0.001, respectively), but the accuracy of SPWMD in predicting reverse remodeling was greater than that of the QRS duration (85% vs. 65%).
CONCLUSIONS: In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.
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Abbreviations and Acronyms
| | AUC | | areas under the curve | | CI | | confidence interval | | CRT | | cardiac resynchronization therapy | | ECG | | electrocardiogram/electrocardiographic/electrocardiography | | EIVD | | electrographic interventricular delay | | ICC | | intraclass correlation coefficient | | IVD | | interventricular delay | | LBBB | | left bundle branch block | | LVEDVI | | left ventricular end-diastolic volume index | | LVEF | | left ventricular ejection fraction | | LVEMD | | left ventricular electromechanical delay | | LVESVI | | left ventricular end-systolic volume index | | MR | | mitral regurgitation | | MRa | | mitral regurgitation area | | MRd | | mitral regurgitation duration | | NYHA | | New York Heart Association | | ROC | | receiver operating characteristic | | SPWMD | | septal-to-posterior wall motion delay |
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