Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy

• Published in: European heart journal Vol. 30; no. 1; pp. 89 - 97
• Main Authors: Rocchi, Guido, Bertini, Matteo, Biffi, Mauro, Ziacchi, Matteo, Biagini, Elena, Gallelli, Ilaria, Martignani, Cristian, Cervi, Elena, Ferlito, Marinella, Rapezzi, Claudio, Branzi, Angelo, Boriani, Giuseppe
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2009; Oxford Publishing Limited (England)
• Subjects: Aged; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiac resynchronization therapy; Cardiology. Vascular system; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - therapy; Cardiovascular system; Echocardiography, Doppler, Pulsed; Echocardiography, Stress; Exercise echocardiography; Exercise Test; Female; Follow-Up Studies; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Medical sciences; Middle Aged; Patient Selection; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sensitivity and Specificity; Tissue Doppler imaging; Ultrasonic investigative techniques; Ventricular Remodeling; Heart failure; Tissue Doppler imaging; Cardiac resynchronization therapy; Exercise echocardiography; Sonography; Physical exercise; Cardiac resynchronization; Echocardiography; Tissue doppler; Instrumentation therapy; Cardiovascular disease; Stress; Left ventricle; Instrumental stimulation; Improvement; Rest; Heart disease; Exercise tolerance test; Medical imagery; Circulatory system; Cardiology
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehn483

Aims Cardiac resynchronization therapy (CRT) improves functional capacity and survival in heart failure. However, one-third of patients fail to respond to CRT. Resting left ventricular (LV) dyssynchrony assessed by echocardiography (ECHO) showed discordant results in identifying CRT responders. LV dyssynchrony can totally change during exercise. Aim of this study was to evaluate whether exercise dyssynchrony could select responders to CRT. Methods and results Sixty-four patients scheduled for CRT implantation performed bicycle exercise ECHO in semi-supine position on an exercise tilting table before and 6 months after CRT implantation. Tissue Doppler imaging (TDI) was acquired both at rest and during exercise to detect LV mechanical dyssynchrony. Predictive values for CRT response were 70% for rest TDI and 89% for exercise TDI (P = 0.01). Exercise LV dyssynchrony was the only parameter independently associated with follow-up improvement of rest ejection fraction and LV volume during multivariable analysis (P < 0.001). Functional improvement at 6-min walking test was statistically higher in patients with exercise dyssynchrony (P = 0.005), and not different considering rest dyssynchrony (P = 0.30). Conclusion Exercise intraventricular dyssynchrony assessed by exercise TDI ECHO is a strong independent predictor of CRT response. It could be used to select candidates for CRT, thus reducing ineffective implantations of biventricular pacemakers.