Contractile reserve assessed using dobutamine echocardiography predicts left ventricular reverse remodeling after cardiac resynchronization therapy: prospective validation in patients with left ventricular dyssynchrony.
[en] Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony whether response to CRT is related to myocardial viability in the region of the pacing lead. Methods: Forty-nine consecutive patients with advanced heart failure, LV ejection fraction < 35%, QRS duration > 120 ms and intraventricular asynchronism ≥ 50 ms were included. Dobutamine stress echocardiography was performed within the week before CRT implantation. Resting echocardiography was performed 6 months after CRT implantation. Viability in the region of LV pacing lead was defined as the presence of viability in two contiguous segments. Response to CRT was defined by evidence of reverse LV remodeling (≥15% reduction in LV end-systolic volume). Results: Thirty-one patients (63%) were identified as responders at follow-up. The average of viable segments was 5.9 ± 2 in responders and 3.2 ± 3 in nonresponders (P = 0.0003). Viability in the region of the pacing lead had a sensitivity of 94%, a specificity of 67%, a positive predictive value of 83%, and a negative predictive value of 86% for the prediction of response to CRT. Conclusions: In patients with LV dyssynchrony, reverse remodeling after CRT requires viability in the region of the pacing lead. This simple method using echocardiography dobutamine for the evaluation of local viability (i.e., viability in two contiguous segments) may be useful to the clinician in choosing the best LV lead positioning.
Disciplines :
Cardiovascular & respiratory systems General & internal medicine
Author, co-author :
Sénéchal, Mario; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Magne, Julien ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Garceau, Patrick; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Champagne, Jean; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Blier, L.; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Molin, F.; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Philippon, F.; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Moonen, Marie ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
O'Hara, G.; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Dubois, M.; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada > Department of Cardiology
Language :
English
Title :
Contractile reserve assessed using dobutamine echocardiography predicts left ventricular reverse remodeling after cardiac resynchronization therapy: prospective validation in patients with left ventricular dyssynchrony.
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