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J Am Coll Cardiol, 2001; 38:1957-1965 © 2001 by the American College of Cardiology Foundation |
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 cardiac resynchronization therapy (CRT) on echocardiographic variables of left ventricular (LV) function.
BACKGROUND: Cardiac resynchronization therapy has recently been introduced as a new therapeutic modality in patients with advanced heart failure (HF) and conduction abnormalities. However, most studies have only investigated the early hemodynamic effects of CRT.
METHODS: Twenty-five patients (12 women and 13 men; 59.8 ± 5.1 years old) with advanced HF caused by ischemic (n = 7) or idiopathic dilated cardiomyopathy (n = 18) and a prolonged QRS complex were analyzed. All patients underwent early hemodynamic testing with a randomized testing protocol; echocardiographic measurements were compared before implantation and after six months of CRT.
RESULTS: Left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD, respectively) were significantly reduced after six months (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 from 253 ± 83 to 227 ± 112 ml, p = 0.017; LVESV from 202 ± 79 to 174 ± 101 ml, p = 0.009). Ejection fraction was significantly increased (from 22 ± 7% to 26 ± 9%, p = 0.03). "Nonresponders," with regard to LV volume reduction, had significantly higher baseline LVEDV, compared with "responders" (351 ± 52 vs. 234 ± 74 ml, p = 0.018). Overall, there was only mild mitral regurgitation at baseline, with a minor reduction by semiquantitative analysis. The results of early hemodynamic testing did not predict the volume response.
CONCLUSIONS: Cardiac resynchronization therapy may lead to a reduction in LV volumes in patients with advanced HF and conduction disturbances. Volume nonresponders have significantly higher baseline LVEDV.
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