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J Am Coll Cardiol, 2002; 40:1615-1622
© 2002 by the American College of Cardiology Foundation
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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{dagger}, Francesco Massari, MD{dagger}, Brian Rizzon, MD*, Giovanni Luzzi, MD*, Pietro Guida, MS*, Andrea Andriani, MD*, Filippo Mastropasqua, MD{dagger} and Paolo Rizzon, MD*

* Institute of Cardiology, University of Bari, Bari, Italy
{dagger} 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.

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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