Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances


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J Am Coll Cardiol, 2001; 38:1957-1965
© 2001 by the American College of Cardiology Foundation

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CLINICAL STUDY: HEART FAILURE

Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances¹

Christoph Stellbrink^a^,*, Ole-Alexander Breithardt^a^,2, Andreas Franke^a^,2, Stefan Sack^b^,2, Patricia Bakker^c^,2, Angelo Auricchio^d^,2, Thierry Pochet^e^,2, Rod Salo^f^,3, Andrew Kramer^f^,3 and Julio Spinelli^f^,3

^a Department of Cardiology, RWTH University of Technology, Aachen, Germany;
^b Department of Cardiology, University Hospital, Essen, Germany;
^c Heart Lung Institute, University Hospital, Utrecht, The Netherlands;
^d Department of Cardiology, University Hospital, Magdeburg, Germany;
^e Guidant Corporation, Brussels, Belgium
^f Guidant Corporation, St. Paul, Minnesota, USA

Manuscript received January 17, 2001; revised manuscript received August 13, 2001, accepted August 22, 2001.

^* Reprint requests and correspondence: Dr. Christoph Stellbrink, Medizinische Klinik I, RWTH Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany.
Christoph.Stellbrink{at}post.rwth-aachen.de

OBJECTIVES: We sought to investigate the impact of six months of cardiacresynchronization therapy (CRT) on echocardiographic variablesof left ventricular (LV) function.

BACKGROUND: Cardiac resynchronization therapy has recently been introducedas a new therapeutic modality in patients with advanced heartfailure (HF) and conduction abnormalities. However, most studieshave only investigated the early hemodynamic effects of CRT.

METHODS: Twenty-five patients (12 women and 13 men; 59.8 ± 5.1years old) with advanced HF caused by ischemic (n = 7) or idiopathicdilated cardiomyopathy (n = 18) and a prolonged QRS complexwere analyzed. All patients underwent early hemodynamic testingwith a randomized testing protocol; echocardiographic measurementswere compared before implantation and after six months of CRT.

RESULTS: Left ventricular end-diastolic and end-systolic diameters (LVEDDand LVESD, respectively) were significantly reduced after sixmonths (LVEDD from 71 ± 10 to 68 ± 11 mm, p =0.027; LVESD from 63 ± 11 to 58 ± 11 mm, p = 0.007),as were LV end-diastolic and end-systolic volumes (LVEDV from253 ± 83 to 227 ± 112 ml, p = 0.017; LVESV from202 ± 79 to 174 ± 101 ml, p = 0.009). Ejectionfraction was significantly increased (from 22 ± 7% to26 ± 9%, p = 0.03). "Nonresponders," with regard to LVvolume reduction, had significantly higher baseline LVEDV, comparedwith "responders" (351 ± 52 vs. 234 ± 74 ml, p= 0.018). Overall, there was only mild mitral regurgitationat baseline, with a minor reduction by semiquantitative analysis.The results of early hemodynamic testing did not predict thevolume response.

CONCLUSIONS: Cardiac resynchronization therapy may lead to a reduction inLV volumes in patients with advanced HF and conduction disturbances.Volume nonresponders have significantly higher baseline LVEDV.

Abbreviations and Acronyms
  BV
  biventricular
  CRT
  cardiac resynchronization therapy
  HF
  heart failure
  LVEDD
  left ventricular end-diastolic diameter
  LVEDV
  left ventricular end-diastolic volume
  LVESD
  left ventricular end-systolic diameter
  LVESV
  left ventricular end-systolic volume
  EF
  ejection fraction
  LV
  left ventricular
  MR
  mitral regurgitation
  RV
  right ventricular

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Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure
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A. Duncan, D. Wait, D. Gibson, and J.-C. Daubert
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A novel use of cardiac pacing to improve cardiac function, quality of life and (hopefully) survival in patients with heart failure and permanent atrial fibrillation
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A. Auricchio, J. Ding, J. C. Spinelli, A. P. Kramer, R. W. Salo, W. Hoersch, B. H. KenKnight, H. U. Klein, and for the PATH-CHF Study Group
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[Abstract] [PDF]

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[Abstract] [PDF]

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Cardiac resynchronization: a cornerstone in the foundation of device therapy for heart failure
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[Full Text] [PDF]

CLINICAL STUDY: HEART FAILURE

Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances1

Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances¹