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CLINICAL RESEARCH: LEFT VENTRICULAR DEFORMATION

Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist

Matteo Bertini, MD^_*,, Nina Ajmone Marsan, MD^_*, Victoria Delgado, MD^_*, Rutger J. van Bommel, MD^_*, Gaetano Nucifora, MD^_*, C. Jan Willem Borleffs, MD^_*, Giuseppe Boriani, MD, PhD, Mauro Biffi, MD, Eduard R. Holman, MD, PhD^_*, Ernst E. van der Wall, MD, PhD^_*,, Martin J. Schalij, MD, PhD^_* and Jeroen J. Bax, MD, PhD^_*,_*

^_* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, University of Bologna, Bologna, Italy
Department of Cardiology, Interuniversity Cardiology Institute of the Netherlands Utrecht, Utrecht, the Netherlands

Manuscript received November 25, 2008; revised manuscript received April 17, 2009, accepted May 4, 2009.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: j.j.bax{at}lumc.nl).

Objectives: This study explored the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) twist, particularly in relation to LV lead position.

Background: LV twist is emerging as a comprehensive index of LV function.

Methods: Eighty heart failure patients were included. Two-dimensional echocardiography was performed at baseline, immediately after CRT, and at 6-month follow-up. Speckle-tracking analysis was applied to assess LV twist. The LV lead was placed preferably in a (postero)lateral vein, and at fluoroscopy, the position was classified as basal, midventricular, or apical. Response to CRT was defined as reduction of LV end-systolic volume 15% at 6-month follow-up. A control group comprised 30 normal subjects.

Results: Peak LV twist in heart failure patients was 4.8 ± 2.6° compared with 15.0 ± 3.6° in the control subjects (p < 0.001). At 6-month follow-up, peak LV twist significantly improved only in responders (56%), from 4.3 ± 2.4° to 8.5 ± 3.2° (p < 0.001). The strongest predictor of response to CRT was the improvement of peak LV twist immediately after CRT (odds ratio: 1.899, 95% confidence interval: 1.334 to 2.703, p < 0.001). Furthermore, LV twist significantly improved in patients with an apical (from 4.3 ± 3.1° to 8.6 ± 3.0°, p = 0.001) and midventricular (from 4.8 ± 2.2° to 6.4 ± 3.9°, p = 0.038) but not with a basal (5.0 ± 3.3° vs. 4.1 ± 3.2°, p = 0.28) LV lead position. Similarly, LV ejection fraction significantly increased in patients with an apical (from 26 ± 7% to 37 ± 7%, p < 0.001) and midventricular (from 26 ± 6% to 33 ± 8%, p < 0.001) but not with a basal (26 ± 5% vs. 28 ± 8%, p = 0.30) LV lead position.

Conclusions: An immediate improvement of LV twist after CRT predicts LV reverse remodeling at 6-month follow-up.

Key Words: heart failure • cardiac resynchronization therapy • left ventricular twist • left ventricular reverse remodeling • left ventricular lead position

Abbreviations and Acronyms   ANOVA = analysis of variance   CRT = cardiac resynchronization therapy   HF = heart failure   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   NYHA = New York Heart Association

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J. Am. Coll. Cardiol. 2009 54: A26. [Full Text] [PDF]