Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome

• Published in: European heart journal Vol. 28; no. 9; pp. 1143 - 1148
• Main Authors: Tournoux, Francois B., Alabiad, Chrisfouad, Fan, Dali, Chen, Annabel A., Chaput, Miguel, Heist, Edwin Kevin, Mela, Theofanie, Mansour, Moussa, Reddy, Vivek, Ruskin, Jeremy N., Picard, Michael H., Singh, Jagmeet P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2007; Oxford Publishing Limited (England)
• Subjects: Aged; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiology. Vascular system; Cardiovascular system; Clinical outcomes; Defibrillators, Implantable; Echocardiography, Doppler; Female; Follow-Up Studies; Heart; Heart Failure - diagnostic imaging; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Mitral Valve Insufficiency - etiology; Myocardial Ischemia - complications; Myocarditis. Cardiomyopathies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Outcome; Ultrasonic investigative techniques; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - therapy; Heart failure; Resynchronization; d; Long-term outcome; Cardiomyopathy; Doppler; Doppler ultrasound study; Cardiac resynchronization; Therapy; Prognosis; Cardiovascular disease; Myocardial disease; Phlebology; Heart disease; Evolution; Cardiology; Sonography; Echocardiography; Acute; Prediction; Instrumentation therapy; Long term; Response; dP/dt; Circulatory system; Hemodynamics
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm050

Aims Although acute haemodynamic improvement in response to cardiac resynchronization therapy (CRT) is reflective of a favourable cardiac contractile response, there is limited information regarding not only its ability to predict long-term clinical outcome but also cardiac-substrate-specific differences in the prognostic value of this measure. Methods and results Fifty-three heart failure patients (69 ± 11 years) with low left ventricle ejection fraction (LVEF) (22 ± 6%), wide QRS (169 ± 31 ms), and indications for CRT were included. There were no significant differences in age, New York Heart Association (NYHA) class, medications, QRS width, or LVEF between ischaemic (n = 37) and non-ischaemic (n = 16) groups. Echocardiograms were performed within 24 h of implantation with device OFF and ON. Acute haemodynamic response was measured as LV dP/dt derived from the CW Doppler of mitral regurgitation. Percentage change in dP/dt was used to classify patients: high- (HR: ΔdP/dt > 25%) or poor-responders (PR: ΔdP/dt ≤ 25%). Clinical response to CRT was defined by a combined endpoint of hospitalizations and all-cause mortality at 12 months. HR group had a significantly better outcome compared to the PR group (P-value = 0.004) irrespective of the aetiology of the cardiomyopathy. Conclusion Echocardiographic assessment of the acute haemodynamic response to CRT predicts long-term clinical outcome in both ischaemic and non-ischaemic cardiomyopathy.