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Acute Left Ventricular Dyssynchrony Improvement Predicts Long‐Term Benefit from Cardiac Resynchronization Therapy
Author(s) -
CAPASSO FABIO,
GIUNTA ANNA,
DE SIMONE ANTONIO,
TURCO PIETRO,
LA ROCCA VINCENZO,
GRIMALDI M. GABRIELLA,
IULIANO ASSUNTA,
STABILE GIUSEPPE
Publication year - 2007
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 - 10.1111/j.1540-8159.2007.00607.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , doppler imaging , heart failure , basal (medicine) , ventricular dyssynchrony , implant , quality of life (healthcare) , ejection fraction , surgery , diastole , blood pressure , nursing , insulin
Study Objective: To evaluate the relationship between acute response to cardiac resynchronization therapy (CRT) and long‐term clinical outcome in patients with drug refractory heart failure.Methods and Results: In 28 patients undergoing CRT implant, left ventricular (LV) dyssynchrony was evaluated by tissue Doppler imaging (TDI)‐derived longitudinal strain by mean of septum‐lateral basal asynchrony index (S‐Li) and basal delayed longitudinal contraction (DLC). TDI measurements were made before, and 30 minutes and 1 year after implant. Baseline and 1‐year follow‐up New York Heart Association (NYHA) functional class, 6‐minute walking test (6‐MWT) distance, and quality of life (QoL) score were measured. Responders (n = 22) were defined by a ≥ 1 decrease in NYHA functional class and 6‐MWT ≥25% at 1 year. At baseline, no differences were observed between responders and nonresponders in clinical and echocardiographic measurements. LV dyssynchrony acutely recovered only in responders 30 minutes after implantation, with a significant reduction in S‐Li and DLC. Moreover, the percent decreases in S‐Li and DLC were highly correlated with those observed in NYHA class (r = 0.70, and r = 0.81, respectively, P < 0.001), 6‐MWT (r = 0.59, and r = 0.57, respectively, P < 0.001 and P < 0.01), and QoL score (r = 0.71, and r = 0.83, respectively, p < 0.001) at 1‐year follow‐up.Conclusions: Acute recovery of LV intraventricular dyssynchrony is a major discriminator between responders and nonresponders to CRT, which strongly correlates with a favorable long‐term clinical outcome.