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Basal Asynchrony and Resynchronization with Biventricular Pacing Predict Long‐Term Improvement of LV Function in Heart Failure Patients
Author(s) -
TOUSSAINT JEANFRANÇOIS,
LAVERGNE THOMAS,
KERROU KHALDOUN,
FROISSART MARC,
OLLITRAULT JACKY,
DARONDEL JEANMARC,
ALONSO CHRISTINE,
DIEBOLD BENOÎT,
LE HEUZEY JEANYVES,
GUIZE LOUIS,
PAILLARD MICHEL
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.t01-1-00275.x
Subject(s) - medicine , cardiology , cardiac resynchronization therapy , ejection fraction , heart failure , qrs complex , asynchrony (computer programming) , basal (medicine) , ventricular dyssynchrony , dilated cardiomyopathy , computer network , asynchronous communication , computer science , insulin
Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long‐term evolution of ventricular function after BiV. Thirty‐four patients (NYHA Class III–IV,65.4 ± 11 years) with large QRS(179 ± 18 ms)were implanted with BiV and studied by RNA before (D 0 ), at day 8 (D 8 ), and during follow‐up(20 ± 7 months). We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from20.2 ± 8.1%(D 0 ) to27.1%± 12.6%(follow‐up,P < 0.003vs D 0 ) and RVEF from28.6%± 13%(D 0 ) to34.3 ± 11.5%(follow‐up,P < 0.03vs D 0 ). Inter‐ (ΔTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from68.3 ± 38 ms(D 0 ) to13.4 ± 48.5 ms(D 8 ) and1.8 ± 39.2 ms(follow‐up,P < 0.0001vs D 0 ); and Tab from45.8 ± 64.1 msto−18 ± 68(D 8 ) and−28.3 ± 53.6 ms(follow‐up,P < 0.0001vs D 0 ). Early inter‐ and intraventricular resynchronization (ΔTab) at D 8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D 0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow‐up. In DCM patients, BiV resynchronizes ventricles early and in the long‐term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV. (PACE 2003; 26:1815–1823)