1. Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy
- Author
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Erwan Donal, Patrizio Lancellotti, Luc Pierard, Emilio Attena, Mario Sénéchal, Bernard Cosyns, Eric Nellessen, Marie Moonen, Pierre Melon, Julien Magne, Service de cardiologie, Université de Liège, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], and CHU Pontchaillou [Rennes]
- Subjects
Male ,MESH: Echocardiography, Doppler ,MESH: Myocardial Contraction ,medicine.medical_treatment ,MESH: Logistic Models ,030204 cardiovascular system & hematology ,Doppler echocardiography ,MESH: Stroke Volume ,Ventricular Dysfunction, Left ,0302 clinical medicine ,[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing ,MESH: Ventricular Dysfunction, Left ,030212 general & internal medicine ,Left ventricular dyssynchrony ,MESH: Aged ,Cardiac resynchronization therapy ,Ejection fraction ,medicine.diagnostic_test ,Ventricular Remodeling ,Cardiac Pacing, Artificial ,General Medicine ,Echocardiography, Doppler ,Predictive factor ,MESH: Reproducibility of Results ,Viability ,Echocardiography ,Cardiology ,cardiovascular system ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,Cardiology and Cardiovascular Medicine ,MESH: Echocardiography, Stress ,[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing ,circulatory and respiratory physiology ,Echocardiography, Stress ,medicine.medical_specialty ,MESH: Cardiac Pacing, Artificial ,MESH: Ventricular Remodeling ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Ventricular remodeling ,Exercise ,Aged ,Heart Failure ,MESH: Humans ,Ventricular End-Systolic Volume ,business.industry ,Reproducibility of Results ,Stroke Volume ,MESH: ROC Curve ,medicine.disease ,Myocardial Contraction ,MESH: Male ,Logistic Models ,ROC Curve ,Heart failure ,MESH: Heart Failure ,business ,MESH: Female - Abstract
International audience; AIMS: Lack of response to cardiac resynchronization therapy (CRT) may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on left ventricular (LV) reverse remodelling (decrease in LV end-systolic volume > or =15% after 6 months of CRT). METHODS AND RESULTS: Fifty-one consecutive patients with heart failure underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve and local contractile reserve (assessed by two-dimensional speckle tracking) in the region of the LV pacing lead. Responders (30 patients) showed a greater exercise-induced increase in left ventricular ejection fraction (LVEF) compared with non-responders (P < 0.001). Contractile reserve was directly related to the improvement in LVEF and to LV reverse remodelling after 6 months of CRT (P < 0.001). A 6.5% exercise-induced increase in LVEF yielded a sensitivity of 90% and a specificity of 85.7% to predict the response after 6 months of CRT. Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders than in non-responders (P < 0.0001). CONCLUSION: Myocardial contractile reserve (global and regional) is a strong predictive factor of LV reverse remodelling after CRT.
- Published
- 2009