Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances1
Christoph Stellbrinka,*,
Ole-Alexander Breithardta,2,
Andreas Frankea,2,
Stefan Sackb,2,
Patricia Bakkerc,2,
Angelo Auricchiod,2,
Thierry Pochete,2,
Rod Salof,3,
Andrew Kramerf,3 and
Julio Spinellif,3
a Department of Cardiology, RWTH University of Technology, Aachen, Germany;
b Department of Cardiology, University Hospital, Essen, Germany;
c Heart Lung Institute, University Hospital, Utrecht, The Netherlands;
d Department of Cardiology, University Hospital, Magdeburg, Germany;
e Guidant Corporation, Brussels, Belgium
f Guidant Corporation, St. Paul, Minnesota, USA
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Figure 1 These end-diastolic echocardiographic images were obtained in the apical four-chamber view before device implantation (left) and after six months of CRT (right), where a volume reduction is demonstrated. The endocardial borders were manually delineated, and the LV cavity area surrounded by these borders was used for LV volume calculation, as explained in the text. Note the reduction in end-diastolic volume and the reduced sphericity of the LV shape in the right image.
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Figure 2 A comparison of LVEDV (A) and LVESV (B) before pacemaker implantation and after six months of hemodynamically optimized pacing. There was a significant decrease in both volumes after six months.
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Figure 3 A comparison of echocardiographically determined EF before pacemaker implantation and after six months of hemodynamically optimized pacing. There was a small but significant increase in EF after six months.
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Figure 4 Percent changes in +dP/dt (A) and pulse pressure (PP) (B), plotted against the baseline LVESV values, as determined by echocardiography. There was no correlation between early hemodynamic improvement in PP or +dP/dt and baseline LV volume. Moreover, long-term volume nonresponders (open circles) were found among high and low early hemodynamic responders (solid diamonds), both for PP and +dP/dt. Three volume nonresponders were among those patients with the highest early hemodynamic response.
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