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Re: LEFT VENTRICULAR VOLUMES AS OUTCOME DETERMINANTS IN CARDIAC RESYNCHRONIZATION THERAPY (CRT)

Dear Editor,

An accurate selection and optimal timing in addressing patients to CRT is important in order to optimize the treatment. Consequently the identification of outcome predictors is critical.

For these reasons we greatly appreciated the paper by Gradaus et al. entitled and stating that “diastolic filling pattern and left ventricular diameter predict response and prognosis after cardiac resynchronization therapy” that adds, on a larger scale, further evidence to the recently “in extenso” reported RESYNC results (Gimelli et al, 2007) about the relevance of the pre-CRT left ventricular dimensions (both systolic and diastolic) on functional response after CRT in patients with chronic heart failure (CHF) and left bundle branch block (LBBB).

Particularly, an indexed left ventricular end-diastolic volume (iLVEDV), i.e. LVEDV/body surface area, upper than 142 ml/square meter at myocardial gated single photon emission computed tomography has been found (Valle et al, 2005) and has been emphasised (Cuocolo et al, 2006) to be a reliable predictor of functional recovery after CRT.

RESYNC study survival branch is still ongoing, however the data already collected agree with those by Gradaus et al. about the critical role of left ventricular dimensions not only on functional outcome but also on the frequency of heart-related fatalities after CRT.

In our opinion, according to Gradaus et al., left ventricular dimensions are critical prognostic parameters and should be carefully taken into account in view of a CRT. Moreover all these data probably justify an earlier recourse to CRT in managing patients with CHF and LBBB.

REFERENCES

1. Cuocolo A. et al.
Eur. J. Nucl. Med. Mol. Imaging 2006; 33: 360-381

2. Gimelli A. et al.
J. Cardiovasc. Med. 2007; 8: 575-581