Open AccessThe Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle‐to‐long‐term Prognosis of Heart Failure Patients
Author(s) -
Kabutoya Tomoyuki,
Mitsuhashi Takeshi,
Watanabe Tomonori,
Nakagami Rieko,
Hata Yoshihito,
Shimada Kazuyuki,
Kario Kazuomi
Publication year - 2011
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/s1880-4276(11)80046-3
Subject(s) - medicine , cardiac resynchronization therapy , ejection fraction , cardiology , heart failure , clinical endpoint , proportional hazards model , randomized controlled trial
Background: The relationship between optimization according to left ventricular (LV) dp/dt, changes in LV performance, and prognosis of heart failure patients who undergo cardiac resynchronization therapy (CRT) remains unclear. Methods: We studied 27 consecutive patients who underwent CRT implantation (18 males, 9 females; age, 67.3 ± 8.3 years). We measured LV dp/dt to determine the timing of LV‐right ventricular (RV) sequential pacing. Echocardiographic examination was performed before and after the CRT procedure to assess LV ejection fraction (LVEF) and LV end‐diastolic diameter (LVEDD). Primary endpoints were all‐cause death and cardiac hospitalization. Results: An increase in LV dp/dt during CRT was significantly associated with an increase in LVEF (r = 0.47, p = 0.018), but was not associated with a decrease in LVEDD. The mean follow‐up period was 14 ± 13 months, and six endpoints were observed. In the control group, no subjects encountered any of the endpoints, and they had higher LVEDD reductions (5.7 ± 8.4 vs. ± 2.5 ± 4.6 mm; p = 0.034) than those in the event group. Cox regression analysis revealed that a reduction in LVEDD was a significant predictor of event‐free survival. Conclusions: The measurement of LV dp/dt might be useful for the optimization of CRT. Reductions in LVEDD are necessary to achieve improvements in the long‐term prognosis of CRT patients.