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Toward understanding response to cardiac resynchronization therapy: left ventricular dyssynchrony is only one of multiple mechanisms
- Source :
- European Heart Journal, European Heart Journal, Oxford University Press (OUP): Policy B, 2009, 30 (8), pp.940-9. ⟨10.1093/eurheartj/ehn481⟩
- Publication Year :
- 2009
- Publisher :
- HAL CCSD, 2009.
-
Abstract
- International audience; AIM: To date, most published echocardiographic methods have assessed left ventricular (LV) dyssynchrony (DYS) alone as a predictor for response to cardiac resynchronization therapy (CRT). We hypothesized that the response is instead dictated by multiple correctable factors. METHODS AND RESULTS: A total of 161 patients (66 +/- 10 years, EF 24 +/- 6%, QRS > 120 ms) were investigated pre- and post-CRT (median of 6 months). Reduction in NYHA Class >/=1 or LV reverse remodelling (end-systolic volume reduction >/= 10%) defined response. Four different pathological mechanisms were identified. Group1: LVDYS characterized by a pre-ejection septal flash (SF) (87 patients, 54%). Elimination of SF (77 of 87 patients) resulted in reverse remodelling in 100%. Group 2: short-AV delay (21 patients, 13%) resolution (19 of 21 patients) resulted in reverse remodelling in 16 of 19. Group 3: long-AV delay (16 patients, 10%) resolution (14 of 16 patients) resulted in NYHA Class reduction >/=1 in 11 with reverse remodelling in five patients. Group 4: exaggerated LV-RV interaction (15 patients, 9%) reduced post-CRT. All responded clinically with fall in pulmonary artery pressure (P = 0.003) but did not volume respond. Group 5: patients with none of the above correctable mechanisms (22 patients, 14%). None responded to CRT. CONCLUSION: CRT response is dictated by correction of multiple independent mechanisms of which LVDYS is only one. Long-axis DYS measurements alone failed to detect 40% of responders.
- Subjects :
- Male
Heart disease
MESH: Myocardial Contraction
Cardiac Volume
medicine.medical_treatment
MESH: Echocardiography, Doppler, Color
030204 cardiovascular system & hematology
MESH: Stroke Volume
Ventricular Dysfunction, Left
0302 clinical medicine
[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing
MESH: Ventricular Dysfunction, Left
Medicine
Prospective Studies
030212 general & internal medicine
MESH: Aged
Cardiac resynchronization therapy
MESH: Middle Aged
Ventricular Remodeling
Cardiac Pacing, Artificial
Dilated cardiomyopathy
Stroke volume
Middle Aged
3. Good health
MESH: Arrhythmias, Cardiac
Echocardiography
Cardiology
Female
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Cardiology and Cardiovascular Medicine
[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing
medicine.medical_specialty
Heart failure
MESH: Ventricular Remodeling
MESH: Cardiac Pacing, Artificial
03 medical and health sciences
QRS complex
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
Humans
Ventricular remodeling
Ventricular dyssynchrony
Aged
MESH: Humans
business.industry
MESH: Cardiac Volume
Arrhythmias, Cardiac
Stroke Volume
medicine.disease
Myocardial Contraction
MESH: Prospective Studies
MESH: Male
Echocardiography, Doppler, Color
MESH: Heart Failure
business
MESH: Female
Subjects
Details
- Language :
- English
- ISSN :
- 0195668X and 15229645
- Database :
- OpenAIRE
- Journal :
- European Heart Journal, European Heart Journal, Oxford University Press (OUP): Policy B, 2009, 30 (8), pp.940-9. ⟨10.1093/eurheartj/ehn481⟩
- Accession number :
- edsair.doi.dedup.....df7a393e2958a5013d5bdfc82c1725a5