Contractile Reserve Assessed Using Dobutamine Echocardiography Predicts Left Ventricular Reverse Remodeling after Cardiac Resynchronization Therapy: Prospective Validation in Patients with Left Ventricular Dyssynchrony

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 27; no. 6; pp. 668 - 676
• Main Authors: Sénéchal, Mario, Lancellotti, Patrizio, Magne, Julien, Garceau, Patrick, Champagne, Jean, Blier, Louis, Molin, Frank, Philippon, François, Marie, Moonen, O'Hara, Gilles, Dubois, Michelle
• Format: Journal Article Web Resource
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.07.2010; Future Pub Co
• Subjects: Aged; Cardiac Resynchronization Therapy; Cardiovascular & respiratory systems; contractile reserve; Dobutamine; dobutamine echocardiography; Echocardiography - methods; Female; General & internal medicine; heart failure; Human health sciences; Humans; LV reverse remodeling; Médecine générale & interne; Prognosis; Prospective Studies; Sciences de la santé humaine; Systèmes cardiovasculaire & respiratoire; Treatment Outcome; Vasodilator Agents; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - prevention & control; Ventricular Remodeling
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/j.1540-8175.2009.01106.x

Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony whether response to CRT is related to myocardial viability in the region of the pacing lead. Methods: Forty‐nine consecutive patients with advanced heart failure, LV ejection fraction < 35%, QRS duration > 120 ms and intraventricular asynchronism ≥ 50 ms were included. Dobutamine stress echocardiography was performed within the week before CRT implantation. Resting echocardiography was performed 6 months after CRT implantation. Viability in the region of LV pacing lead was defined as the presence of viability in two contiguous segments. Response to CRT was defined by evidence of reverse LV remodeling (≥15% reduction in LV end‐systolic volume). Results: Thirty‐one patients (63%) were identified as responders at follow‐up. The average of viable segments was 5.9 ± 2 in responders and 3.2 ± 3 in nonresponders (P = 0.0003). Viability in the region of the pacing lead had a sensitivity of 94%, a specificity of 67%, a positive predictive value of 83%, and a negative predictive value of 86% for the prediction of response to CRT. Conclusions: In patients with LV dyssynchrony, reverse remodeling after CRT requires viability in the region of the pacing lead. This simple method using echocardiography dobutamine for the evaluation of local viability (i.e., viability in two contiguous segments) may be useful to the clinician in choosing the best LV lead positioning. (Echocardiography 2010;27:668‐676)