Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy.
نویسندگان
چکیده
OBJECTIVE To explore the left ventricular (LV) electrical activation pattern in heart failure (HF) and its implication to cardiac resynchronization therapy (CRT). DESIGN AND SETTING Observational study at the University Teaching Hospital. PATIENTS 23 optimally treated patients with HF with New York Heart Association class III, QRS duration >120 ms and LV ejection fraction <35%. INTERVENTIONS The LV endocardial activation pattern and total activation time (Tat) was determined by non-contact mapping and the LV mechanical dys-synchrony was determined by standard deviation (Ts-SD) and maximal difference (Ts-diff) of time to peak systolic contraction (Ts) among 12 LV segments using tissue Doppler imaging before receiving CRT. MAIN OUTCOME MEASURES Correlation between electrical and mechanical dys-synchrony; volumetric responder to CRT at 3 months; HF hospitalisation or death by Kaplan-Meier analysis. RESULTS Homogenous (type I, n = 8) and presence of conduction block (type II, n = 15) patterns were identified. Significant correlation between Tat and Ts-SD/Ts-diff was noted only in type II (r = 0.73/0.56, p = 0.002/0.03). Ts-SD and Ts-diff in type II were significantly longer than type I. 12 patients in type II and 2 in type I were CRT responders (p = 0.01). After 487 (447) days, patients with type II pattern had significantly lower risk of HF hospitalisation or death than those with type I (log rank chi(2) = 5.25; p = 0.02). CONCLUSION Patients with type II LV endocardial activation pattern had a more favourable echocardiographic and clinical response to CRT than those with type I pattern.
منابع مشابه
RAPID COMMUNICATION Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy
Objective: To explore the left ventricular (LV) electrical activation pattern in heart failure (HF) and its implication to cardiac resynchronization therapy (CRT). Design and setting: Observational study at the University Teaching Hospital. Patients: 23 optimally treated patients with HF with New York Heart Association class III, QRS duration .120 ms and LV ejection fraction ,35%. Interventions...
متن کاملCirculation: Cardiovascular Imaging Topic Review Circulation: Cardiovascular Imaging Editors’ Picks
The absence of clinical response in 30% to 40% of patients receiving cardiac resynchronization therapy (CRT) poses a great challenge to heart failure clinicians and device implanters. It is well documented that positioning of the left ventricular (LV) lead in areas of myocardial scar in patients with ischemic cardiomyopathy is associated with a diminished response to CRT. Regions of slow conduc...
متن کاملCirculation: Cardiovascular Imaging Topic Review Circulation: Cardiovascular Imaging Editors’ Picks
The absence of clinical response in 30% to 40% of patients receiving cardiac resynchronization therapy (CRT) poses a great challenge to heart failure clinicians and device implanters. It is well documented that positioning of the left ventricular (LV) lead in areas of myocardial scar in patients with ischemic cardiomyopathy is associated with a diminished response to CRT. Regions of slow conduc...
متن کاملSingle-Beat Noninvasive Imaging of Ventricular Endocardial and Epicardial Activation in Patients Undergoing CRT
BACKGROUND Little is known about the effect of cardiac resynchronization therapy (CRT) on endo- and epicardial ventricular activation. Noninvasive imaging of cardiac electrophysiology (NICE) is a novel imaging tool for visualization of both epi- and endocardial ventricular electrical activation. METHODOLOGY/PRINCIPAL FINDINGS NICE was performed in ten patients with congestive heart failure (C...
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عنوان ژورنال:
- Heart
دوره 93 4 شماره
صفحات -
تاریخ انتشار 2007