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Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay,

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay   (Citations: 174)
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Background—VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony. Methods and Results—Twenty-two DCM patients with conduction delay were studied by cardiac catheterization with a dual-sensor micromanometer to measure LV and aortic pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced isovolumetric (dP/dtmax) and ejection-phase (pulse pressure, PP) systolic function by 35621% and 16.4611%, respectively, and these changes correlated directly ( r50.7, P50.001). %DdP/dtmax was weakly predicted by baseline QRS (r50.6, P,0.02), more strongly by baseline dP/dtmax (r50.7, P50.001), and best by bidiscriminate analysis combining baseline dP/dtmax #700 mm Hg/s and QRS $155 ms to predict %DdP/dtmax $25% and %DPP $10% (P,0.0005, x2), with no false-positives. Benefit could not be predicted by %DQRS. To test whether basal mechanical dyssynchrony predicted responsiveness to LV pacing, circumferential strains were determined at '80 sites throughout the LV by tagged MRI in 8 DCM patients and 7 additional control subjects. Strain variance at time of maximal shortening indexed dyssynchrony, averaging 28.067.1% in normal subjects versus 201.4684.3% in DCM patients (P50.001). Mechanical dyssynchrony also correlated directly with %DdP/dtmax (r50.85, P50.008). Conclusions—These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dtmax provides an excellent tool to identify maximal responders. (Circulation. 2000;101:2703-2709.)
Published in 2010.
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    • ...Is there evidence to suggest that CRT implantation during the admission for heart failure would have potential immediate benefit? Nelson et al. demonstrated an increase of 35 ± 21% in isovolumetric systolic function, as measured by dP/dtmax, in 22 patients with dilated cardiomyopathy [29]...

    Norman C. Wanget al. The potential role of cardiac resynchronization therapy in acute heart...

    • ...While several measures of mechanical dyssynchrony are commonly used in ultrasound, such as tissue Doppler imaging (velocity [9, 10], strain [11]) or 3D-echo (volume [12, 13]), MRI predominantly focuses on circumferential strain [6, 14]...

    Iris K. Rüsselet al. Relation between three-dimensional echocardiography derived left ventr...

    • ...Multiple well controlled studies have indicated that it is this heterogeneity of wall stress and deformation that determines both the functional impairment as well as the remodelling observed in the dyssynchronous ventricle [2,6-8,10,12- 14]...
    • ...The coefficient of variation of endsystolic strains (CVeS) was calculated to express the effects of dyssynchrony in terms of heterogeneity in strain amplitudes at end-ejection [13]...
    • ...Nelson et al. used CVeS as a marker of dyssynchrony in patients with idiopathic dilated cardiomyopathy and demonstrated that CVeS strongly predicted the acute benefit of CRT [13]...
    • ...Nevertheless, and in spite of using longitudinal instead of circumferential deformation, our ISF, dispersion, and vector data on mechanical activation and dyssynchrony closely resemble the published MR-T data in normal individuals and in patients with LBBB [13,19,20,34]...

    Bart WL De Boecket al. Three-dimensional mapping of mechanical activation patterns, contracti...

    • ...The influence of biventricular pacing on static changes in PP Several studies reported an improvement in dP/dtmax as a measure of isovolumic systolic function and in PP as a surrogate of stroke volume during biventricular pacing in patients with heart failure and intraventricular conduction delay [5,22]...
    • ...Other authors have reported an increase of 4 to 8 mm Hg [6,22]...

    Cornelius Keylet al. Changes in pulse pressure variability during cardiac resynchronization...

    • ...The coefficient of strain variation (CV), described by Nelson et al. [8] was used to evaluate the heterogeneity in endsystolic circumferential peak shortening as an additional parameter to measure mechanical LV dyssynchrony...

    Vroni van der Landet al. The effect of left bundle branch block on left ventricular remodeling,...

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