Heart 2001;85:514-520 ( May )

Cardiovascular medicine

Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure W Y Kim, P Søgaard, P T Mortensen, H Kjærulf Jensen, A Kirstein Pedersen, B Ø Kristensen, H Egeblad

Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark

Correspondence to: Dr Kim skejyk{at}aau.dk

Accepted 13 December 2000

OBJECTIVESTo quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.
DESIGNThree dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2-7 days) biventricular pacing.
RESULTSCompared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r² = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %EDV, %ESV, and %FSV.
CONCLUSIONSIn five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.


Keywords: heart failure; left ventricular volume; pacing; three dimensional echocardiography

---

© 2001 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• van Campen, C M C, Visser, F C, de Cock, C C, Vos, H S, Kamp, O, Visser, C A (2006). Comparison of the haemodynamics of different pacing sites in patients undergoing resynchronisation treatment: need for individualisation of lead localisation. Heart 92: 1795-1800 [Abstract] [Full Text]  
• Kies, P, Leclercq, C, Bleeker, G B, Crocq, C, Molhoek, S G, Poulain, C, van Erven, L, Bootsma, M, Zeppenfeld, K, van der Wall, E E, Daubert, J-C, Schalij, M J, Bax, J J (2006). Cardiac resynchronisation therapy in chronic atrial fibrillation: impact on left atrial size and reversal to sinus rhythm. Heart 92: 490-494 [Abstract] [Full Text]  
• Lecoq, G., Leclercq, C., Leray, E., Crocq, C., Alonso, C., Place, C. d., Mabo, P., Daubert, C. (2005). Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure. Eur Heart J 26: 1094-1100 [Abstract] [Full Text]  
• Lane, R E, Chow, A W C, Chin, D, Mayet, J (2004). Selection and optimisation of biventricular pacing: the role of echocardiography. Heart 90: vi10-vi16 [Abstract] [Full Text]  
• Bax, J. J., Ansalone, G., Breithardt, O. A., Derumeaux, G., Leclercq, C., Schalij, M. J., Sogaard, P., St. John Sutton, M., Nihoyannopoulos, P. (2004). Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use?: A critical appraisal. J Am Coll Cardiol 44: 1-9 [Abstract] [Full Text]  
• Simantirakis, E. N., Vardakis, K. E., Kochiadakis, G. E., Manios, E. G., Igoumenidis, N. E., Brignole, M., Vardas, P. E. (2004). Left ventricular mechanics during right ventricular apical or left ventricular-based pacing in patients with chronic atrial fibrillation after atrioventricular junction ablation. J Am Coll Cardiol 43: 1013-1018 [Abstract] [Full Text]  
• Levine, R. A., Hung, J. (2003). Ischemic mitral regurgitation, the dynamic lesion: clues to the cure. J Am Coll Cardiol 42: 1929-1932 [Full Text]  
• Breithardt, O. A., Sinha, A. M., Schwammenthal, E., Bidaoui, N., Markus, K. U., Franke, A., Stellbrink, C. (2003). Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 41: 765-770 [Abstract] [Full Text]  
• Nielsen, J. C., Bottcher, M., Jensen, H. K., Nielsen, T. T., Pedersen, A. K., Mortensen, P. T. (2003). Regional myocardial perfusion during chronic biventricular pacing and after acute change of the pacing mode in patients with congestive heart failure and bundle branch block treated with an atrioventricular sequential biventricular pacemaker. Eur J Heart Fail 5: 179-186 [Abstract] [Full Text]  
• Fauchier, L., Marie, O., Casset-Senon, D., Babuty, D., Cosnay, P., Fauchier, J. P. (2002). Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: A prognostic study with fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 40: 2022-2030 [Abstract] [Full Text]  
• Sogaard, P., Egeblad, H., Pedersen, A. K., Kim, W. Y., Kristensen, B. O., Hansen, P. S., Mortensen, P. T. (2002). Sequential Versus Simultaneous Biventricular Resynchronization for Severe Heart Failure: Evaluation by Tissue Doppler Imaging. Circulation 106: 2078-2084 [Abstract] [Full Text]  
• Sogaard, P., Egeblad, H., Kim, W. Y., Jensen, H. K., Pedersen, A. K., Kristensen, B. O., Mortensen, P. T. (2002). Tissue doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol 40: 723-730 [Abstract] [Full Text]  
• Kawaguchi, M., Murabayashi, T., Fetics, B. J., Nelson, G. S., Samejima, H., Nevo, E., Kass, D. A. (2002). Quantitation of basal dyssynchrony and acute resynchronization from left or biventricular pacing by novel echo-contrast variability imaging. J Am Coll Cardiol 39: 2052-2058 [Abstract] [Full Text]  
• Porciani, M. C., Sabini, A., Colella, A., Michelucci, A., Musilli, N., Pieragnoli, P., Padeletti, L. (2002). Interatrial septum pacing avoids the adverse effect of interatrial delay in biventricular pacing: an echo-Doppler evaluation. Europace 4: 317-324 [Abstract]  
• Stellbrink, C., Breithardt, O.-A., Franke, A., Sack, S., Bakker, P., Auricchio, A., Pochet, T., Salo, R., Kramer, A., Spinelli, J. (2001). Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances. J Am Coll Cardiol 38: 1957-1965 [Abstract] [Full Text]