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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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Eur Heart JHome page
D. Mele, G. Pasanisi, F. Capasso, A. De Simone, M.-A. Morales, D. Poggio, A. Capucci, G. Tabacchi, L. Sallusti, and R. Ferrari
Left intraventricular myocardial deformation dyssynchrony identifies responders to cardiac resynchronization therapy in patients with heart failure
Eur. Heart J., May 1, 2006; 27(9): 1070 - 1078.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
Load dependence of cardiac output in biventricular pacing: left ventricular volume overload in pigs.
J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 666 - 670.



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HeartHome page
F. A Flachskampf and J.-U. Voigt
Echocardiographic methods to select candidates for cardiac resynchronisation therapy.
Heart, March 1, 2006; 92(3): 424 - 429.
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CirculationHome page
M. S. Suffoletto, K. Dohi, M. Cannesson, S. Saba, and J. Gorcsan III
Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy
Circulation, February 21, 2006; 113(7): 960 - 968.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
C. D'Ascia, A. Cittadini, M. G. Monti, G. Riccio, and L. Sacca
Effects of biventricular pacing on interstitial remodelling, tumor necrosis factor-{alpha} expression, and apoptotic death in failing human myocardium
Eur. Heart J., January 2, 2006; 27(2): 201 - 206.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al.
Cardiac Resynchronization Therapy: Part 1--Issues Before Device Implantation
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2153 - 2167.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Kashani and S. S. Barold
Significance of QRS Complex Duration in Patients With Heart Failure
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2183 - 2192.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. M. Aranda Jr, G. W. Woo, R. S. Schofield, E. M. Handberg, J. A. Hill, A. B. Curtis, S. F. Sears, J. S. Goff, D. F. Pauly, and J. B. Conti
Management of Heart Failure After Cardiac Resynchronization Therapy: Integrating Advanced Heart Failure Treatment With Optimal Device Function
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2193 - 2198.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. M. Marcus, E. Rose, E. M. Viloria, J. Schafer, T. De Marco, L. A. Saxon, E. Foster, and for the VENTAK CHF/CONTAK-CD Biventricular Pacing
Septal to Posterior Wall Motion Delay Fails to Predict Reverse Remodeling or Clinical Improvement in Patients Undergoing Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2208 - 2214.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. J.M. Zwanenburg, M. J.W. Gotte, J. T. Marcus, J. P.A. Kuijer, P. Knaapen, R. M. Heethaar, and A. C. van Rossum
Propagation of Onset and PeakTime of Myocardial Shortening in Time of Myocardial Shortening in Ischemic Versus Nonischemic Cardiomyopathy: Assessment by Magnetic Resonance Imaging Myocardial Tagging
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2215 - 2222.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. C. Lardo, T. P. Abraham, and D. A. Kass
Magnetic Resonance Imaging Assessment of Ventricular Dyssynchrony: Current and Emerging Concepts
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2223 - 2228.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
I. Schuster, G. Habib, C. Jego, F. Thuny, J.-F. Avierinos, G. Derumeaux, L. Beck, C. Medail, F. Franceschi, S. Renard, et al.
Diastolic Asynchrony Is More Frequent Than Systolic Asynchrony in Dilated Cardiomyopathy and Is Less Improved by Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2250 - 2257.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. Gorcsan III
Echocardiographic Strain Imaging for Myocardial Viability: An Improvement Over Visual Assessment?
Circulation, December 20, 2005; 112(25): 3820 - 3822.
[Full Text] [PDF]


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Eur J EchocardiogrHome page
K. Dohi, M. Suffoletto, S. Murali, R. Bazaz, and J. Gorcsan
Benefit of cardiac resynchronization therapy to a patient with a narrow QRS complex and ventricular dyssynchrony identified by tissue synchronization imaging
Eur J Echocardiogr, December 1, 2005; 6(6): 455 - 460.
[Abstract] [Full Text] [PDF]



 
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