Original article
Evaluation of ventricular synchrony using novel Doppler echocardiographic indices in patients with heart failure receiving cardiac resynchronization therapy

https://doi.org/10.1016/j.echo.2004.04.012Get rights and content

Abstract

Cardiac resynchronization therapy improves hemodynamics in selected patients with heart failure. Mechanic asynchrony parameters that may guide patient selection or therapy optimization are still being investigated. A biventricular (BiV) pacemaker was implanted in 34 patients with dilated ischemic, idiopathic, or valvular cardiomyopathy, and a QRS duration of ≥130 milliseconds. Two-dimensional standard and Doppler tissue echocardiography was performed during right ventricular (RV), left ventricular (LV), BiV, and no pacing in a random and blinded manner. LV and BiV pacing increased stroke volume (P < .02 for both) and ejection fraction (P < .001 for both). Regional contractility assessed by displacement, strain rate, and peak systolic strain was improved in some segments (P < .05) during LV and BiV pacing. A homogenization of segmental contractions was observed during LV and BiV pacing as evaluated by net systolic displacement and segmental myocardial performance index. LV and BiV pacing provides benefits that can be quantified by echocardiography.

Section snippets

Patients

A total of 34 consecutive patients with dilated ischemic (20), primary (13), or valvular (1) cardiomyopathy (61 ± 15 years; 25 men) were enrolled between March 2001 and March 2002. Inclusion criteria were symptomatic functional class New York Heart Association class II to IV; QRS duration ≥ 130 milliseconds; LV ejection fraction ≤ 35%; LV end-diastolic diameter ≥ 55 mm; and a stable pharmacologic regimen of diuretics, angiotensin-converting enzyme inhibitors, and β-blockers (unless otherwise

Patients characteristics

Initial average QRS complex duration was 184 ± 20 milliseconds. A LBBB pattern was present in all but one patient, who had a right bundle branch block pattern. The LV pacing lead was placed in the posterior-lateral or lateral position in 24 patients (70.5%) and in a posterior or anterior position for 10 (29.5%). The RV pacing lead was positioned in the apex in 28 patients, on the septal wall in 5 patients, and in the RV outflow tract in 1 patient. The intrinsic sinus rate was 64 ± 10 bpm, and

Discussion

The major finding of this study is that LV or BiV pacing at an optimal atrio-ventricular delay could significantly and consistently improve LV systolic function of patients with moderate to severe chronic heart failure and a LBBB. The therapy was associated with improved contraction synchrony between opposite LV walls. In this group of patients, LV pacing produced comparable effects with BiV pacing with respect to LV function.

References (23)

Cited by (43)

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