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Scientific letters
Restrictive transmitral filling patterns predict improvements in left ventricular function after biventricular pacing
  1. R Thaman,
  2. R T Murphy,
  3. S Firoozi,
  4. S M Hamid,
  5. J R Gimeno,
  6. B Sachdev,
  7. V Paul,
  8. E Rowland,
  9. M P Frenneaux,
  10. P M Elliott
  1. Department of Cardiological Sciences, St George’s Hospital Medical School, London, UK
  1. Correspondence to:
    Dr Perry Elliott, Department of Cardiological Sciences, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK;
    pelliott{at}sghms.ac.uk

https://doi.org/10.1136/heart.89.9.1087

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    Numerous studies have shown that biventricular pacing (BVP) improves symptoms and exercise capacity in patients with congestive cardiac failure (CCF) and left bundle branch block (LBBB). The mechanism of symptomatic improvement has been attributed to changes in ventricular synchrony. However, the degree of asynchrony is not a good predictor of response.1,2 The aim of this study was to assess whether the presence of a restrictive mitral filling pattern, previously shown to be a marker for diastolic ventricular interaction (DVI) in patients with CCF,3 might identify a cohort of patients more likely to respond to BVP.

    METHODS

    We studied 23 consecutively referred patients (15 males/8 females), mean (SD) age 63.4 (12.8) years (range 40–83 years) in sinus rhythm with severe refractory heart failure (New York Heart Association (NYHA) III/IV), LBBB (QRS > 120 ms), and fractional shortening (FS) < 25% on maximal tolerated doses of medication, Clinical evaluation included history, ECG, M mode and two dimensional echocardiography before and six months after BVP. At six month follow up patients were classified as responders if there was an improvement in FS > 5% from baseline.

    RESULTS

    Implantation of the biventricular system was successful in 19 patients (83%). Before implant, all patients were receiving either an angiotensin converting enzyme inhibitor or an angiotensin II blocker. All patients were receiving frusemide (furosemide) (mean (SD) dose was 119 (46) …

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