CLINICAL STUDY
Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy
Ole A. Breithardt, MD*,
Christoph Stellbrink, MD*,*,
Andrew P. Kramer, PhD ,
Anil M. Sinha, MD*,
Andreas Franke, MD*,
Rodney Salo, MSc,
Bernhard Schiffgens, BSc*,
Etienne Huvelle, MD ,
Angelo Auricchio, MD, PhD PATH-CHF Study Group
* Department of Cardiology, University Hospital, Aachen, Germany
Guidant Corporation, St. Paul, Minnesota, USA
Guidant Corporation, Brussels, Belgium
Department of Cardiology, University Hospital, Magdeburg, Germany
Manuscript received February 11, 2002;
revised manuscript received April 1, 2002,
accepted April 4, 2002.
* Reprint requests and correspondence: Dr. Christoph Stellbrink, Medizinische Klinik I der RWTH Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany.
cstellbrink{at}ukaachen.de
OBJECTIVES: We sought to determine whether radial left ventricular (LV) asynchrony in patients with heart failure predicts systolic function improvement with cardiac resynchronization therapy (CRT).
BACKGROUND: We quantified LV wall motion by echocardiography to correlate the effects of CRT on LV systolic function with wall motion synchrony.
METHODS: Thirty-four patients underwent echocardiographic phase analysis of LV septal and lateral wall motion and hemodynamic testing before CRT. Phase relationships were measured by the difference between the lateral ( L) and septal (S) wall motion phase angles: LS = L – S. The absolute value of LS was used as an order-independent measure of synchrony: |LS| = |L – S|.
RESULTS: Three phase relationships were identified (mean ± SD): type 1 (n = 4; peak positive LV pressure [dP/dtmax] 692 ± 310 mm Hg/s; LS = 5 ± 6°, synchronous wall motion); type 2 (n = 17; dP/dtmax 532 ± 148 mm Hg/s; LS = 77 ± 33°, delayed lateral wall motion); and type 3 (n = 13; dP/dtmax 558 ± 154 mm Hg/s; LS = –115 ± 33°, delayed septal wall motion, triphasic). A large |LS| predicted a larger increase in dP/dtmax with CRT (r = 0.74, p < 0.001). Sixteen patients were studied during right ventricular (RV), LV and biventricular (BV) pacing. Cardiac resynchronization therapy acutely reduced |LS| from 104 ± 41° (OFF) to 86 ± 45° (RV; p = 0.14 vs. OFF), 71 ± 50° (LV; p = 0.001 vs. OFF) and 66 ± 42° (BV; p = 0.001 vs. OFF). A reduction in |LS| predicted an improvement in dP/dtmax in type 2 patients for LV (r = 0.87, p = 0.005) and BV CRT (r = 0.73, p = 0.04).
CONCLUSIONS: Echocardiographic quantification of LV asynchrony identifies patients likely to have improved systolic function with CRT. Improved synchrony is directly related to improved hemodynamic systolic function in type 2 patients.
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Abbreviations and Acronyms
| | ANOVA | | analysis of variance | | AV | | atrioventricular | | BV | | biventricular | | CAD | | coronary artery disease | | CRT | | cardiac resynchronization therapy | | DCM | | dilated (nonischemic) cardiomyopathy | | LBBB | | left bundle branch block | | L-S | | lateral-septal | | LV | | left ventricular | | dP/dtmax | | peak positive left ventricular pressure | | NYHA | | New York Heart Association | | PATH-CHF | | Pacing Therapies for Congestive Heart Failure study | | RV | | right ventricular |
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