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ELECTROPHYSIOLOGY AND HEART FAILURE

Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing

Hôpital Cardiologique du Haut Leveque, Pessac, France

Manuscript received March 26, 2004; accepted August 23, 2004.

^* Reprint requests and correspondence: Dr. Stephane Garrigue, Hôpital Cardiologique du Haut Lévèque, 19 Avenue de Magellan, Pessac Cedex 33604, France (Email: stephane.garrigue{at}chu-bordeaux.fr).

OBJECTIVES: We sought to evaluate the relationship between hemodynamic and ventricular dyssynchrony parameters in patients undergoing simultaneous and sequential biventricular pacing (BVP).

BACKGROUND: Various echocardiographic parameters of ventricular dyssynchrony have been proposed to screen and optimize BVP therapy.

METHODS: Forty-one patients with heart failure undergoing BVP implantation were studied. Echocardiography coupled with tissue tracking and pulsed Doppler tissue imaging (DTI) was performed before and after BVP implantation and after three months of optimized BVP. Indexes of inter- or intraventricular dyssynchrony were correlated with hemodynamic changes during simultaneous and sequential BVP (10 intervals of right ventricular [RV] or left ventricular [LV] pre-excitation).

RESULTS: Variations in intra-LV delay_peak, intra-LV delay_onset, and index of LV dyssynchrony measured by pulsed DTI were highly correlated with those of cardiac output (r = –0.67, r = –0.64, and r = –0.67, respectively; p < 0.001) and mitral regurgitation (r = 0.68, r = 0.63, and r = 0.68, respectively; p < 0.001), whereas variations in the extent of myocardium displaying delayed longitudinal contraction (r = –0.48 and r = 0.51, respectively; p < 0.05) and the variations in septal-to-posterior wall motion delay (r = –0.41, p < 0.05 and r = 0.24, p = NS, respectively) were less correlated. The changes in interventricular dyssynchrony were not significantly correlated (p = NS). Compared with simultaneous BVP, individually optimized sequential BVP significantly increased cardiac output (p < 0.01), decreased mitral regurgitation (p < 0.05), and improved all parameters of intra-LV dyssynchrony (p < 0.01). At three months, a significant reverse mechanical LV remodeling was observed with significantly decreased LV volumes (p < 0.01) associated with an increased LV ejection fraction (p = 0.035).

CONCLUSIONS: Specific echocardiographic measurements of ventricular dyssynchrony are highly correlated with hemodynamic changes and may be a useful adjunct in the selection and optimization of BVP. Individually optimized sequential BVP provided a significant early hemodynamic improvement compared with simultaneous BVP.

Abbreviations and Acronyms   AV = atrioventricular   BVP = biventricular pacing   CRT = cardiac resynchronization therapy   DLC = delayed longitudinal contraction   EROA = effective regurgitant orifice area   LV = left ventricular   MR = mitral regurgitation   PISA = proximal isovelocity surface area   RV = right ventricular   TDI = tissue Doppler imaging

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