Clinical study: heart failure
Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances1

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Abstract

Objectives

We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on echocardiographic variables of left ventricular (LV) function.

Background

Cardiac resynchronization therapy has recently been introduced as a new therapeutic modality in patients with advanced heart failure (HF) and conduction abnormalities. However, most studies have only investigated the early hemodynamic effects of CRT.

Methods

Twenty-five patients (12 women and 13 men; 59.8 ± 5.1 years old) with advanced HF caused by ischemic (n = 7) or idiopathic dilated cardiomyopathy (n = 18) and a prolonged QRS complex were analyzed. All patients underwent early hemodynamic testing with a randomized testing protocol; echocardiographic measurements were compared before implantation and after six months of CRT.

Results

Left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD, respectively) were significantly reduced after six months (LVEDD from 71 ± 10 to 68 ± 11 mm, p = 0.027; LVESD from 63 ± 11 to 58 ± 11 mm, p = 0.007), as were LV end-diastolic and end-systolic volumes (LVEDV from 253 ± 83 to 227 ± 112 ml, p = 0.017; LVESV from 202 ± 79 to 174 ± 101 ml, p = 0.009). Ejection fraction was significantly increased (from 22 ± 7% to 26 ± 9%, p = 0.03). “Nonresponders,” with regard to LV volume reduction, had significantly higher baseline LVEDV, compared with “responders” (351 ± 52 vs. 234 ± 74 ml, p = 0.018). Overall, there was only mild mitral regurgitation at baseline, with a minor reduction by semiquantitative analysis. The results of early hemodynamic testing did not predict the volume response.

Conclusions

Cardiac resynchronization therapy may lead to a reduction in LV volumes in patients with advanced HF and conduction disturbances. Volume nonresponders have significantly higher baseline LVEDV.

Abbreviations

BV
biventricular
CRT
cardiac resynchronization therapy
HF
heart failure
LVEDD
left ventricular end-diastolic diameter
LVEDV
left ventricular end-diastolic volume
LVESD
left ventricular end-systolic diameter
LVESV
left ventricular end-systolic volume
EF
ejection fraction
LV
left ventricular
MR
mitral regurgitation
RV
right ventricular

Cited by (0)

1

The PAcing THerapies in Congestive Heart Failure (PATH-CHF) study was supported by a grant from the Guidant Corporation (St. Paul, Minnesota). Drs. Pochet, Salo, Kramer and Spinelli have corporate appointments with Guidant Corp.

2

On behalf of the CPI Guidant Congestive Heart Failure Research Group.

3

On behalf of the PATH-CHF Investigators.