(Circulation. 2000;102:3053.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Left Ventricular or Biventricular Pacing Improves Cardiac Function at Diminished Energy Cost in Patients With Dilated Cardiomyopathy and Left Bundle-Branch Block
From the Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md. Dr Spinelli is now at Guidant, St. Paul, Minn.
Correspondence to David A. Kass, MD, Halsted 500, The Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287. E-mail dkass{at}bme.jhu.edu
Background—Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand.
Methods and Results—Ten
DCM patients with left bundle-branch block (ejection fraction 20±3%,
QRS duration179±3 ms, mean±SEM) underwent cardiac
catheterization to measure ventricular and
aortic pressure, coronary blood flow,
arterial–coronary sinus oxygen difference
(
AVO2), and
M
O2. Data were measured under sinus
rhythm or with left ventricular or
biventricular pacing/stimulation at the same heart rate.
These results were then contrasted to intravenous
dobutamine (n=7) titrated to match systolic changes
during LV pacing. Systolic function rose quickly and
substantially from LV pacing (18±4% rise in arterial
pulse pressure, which correlates with cardiac output, and 43±6%
increase in dP/dtmax; both
P<0.01). However,
AVO2 and MO2
declined -4±2% and -8±6.5%, respectively (both
P<0.05). Similar results were
obtained with biventricular activation. In contrast,
dobutamine raised dP/dtmax 37±6%,
accompanied by a 22±11% rise in per-beat
MO2
(P<0.05 versus
pacing).
Conclusions—Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.
Key Words: heart failure • bundle-branch block • pacing • oxygen
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E. A. Bacha, F. J. Zimmerman, V. Mor-Avi, L. Weinert, J. P. Starr, L. Sugeng, and R. M. Lang Ventricular Resynchronization by Multisite Pacing Improves Myocardial Performance in the Postoperative Single-Ventricle Patient Ann. Thorac. Surg., November 1, 2004; 78(5): 1678 - 1683. [Abstract] [Full Text] [PDF]
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P. Knaapen, L. M.C. van Campen, C. C. de Cock, M. J.W. Gotte, C. A. Visser, A. A. Lammertsma, and F. C. Visser Effects of Cardiac Resynchronization Therapy on Myocardial Perfusion Reserve Circulation, August 10, 2004; 110(6): 646 - 651. [Abstract] [Full Text] [PDF]
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L. Faber, B. Lamp, J. Vogt, and D. Horstkotte Tissue Doppler imaging in patients with congestive heart failure and conduction disorders Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D10 - D15. [Abstract] [Full Text] [PDF]
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O. A. Breithardt, L. Herbots, J. D'Hooge, P. Claus, B. Bijnens, C. Stellbrink, A. Franke, and G. R. Sutherland Strain rate imaging in CRT candidates Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D16 - D24. [Abstract] [Full Text] [PDF]
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J. Vogt, J. Heintze, B. Lamp, B. Hansky, and D. Horstkotte Standard haemodynamic measurements Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D29 - D34. [Abstract] [Full Text] [PDF]
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P. Steendijk, S. A.F. Tulner, M. Wiemer, R. A. Bleasdale, J. J. Bax, E. E. van der Wall, J. Vogt, and M. J. Schalij Pressure-volume measurements by conductance catheter during cardiac resynchronization therapy Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D35 - D42. [Abstract] [Full Text] [PDF]
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J. P Boehmer CRT only or CRT plus ICD? Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D83 - D87. [Abstract] [Full Text] [PDF]
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D Baller, J Vogt, O Lindner, B Lamp, J Holzinger, A Kammeier, P Wielepp, W Burchert, and D Horstkotte Myocardial oxygen consumption and perfusion before and after cardiac resynchronization therapy: experimental observations and clinical implications Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D91 - D97. [Abstract] [Full Text] [PDF]
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D. Gras, J. P. Cebron, P. Brunel, B. Leurent, and Y. Banus The selection of patients for cardiac resynchronization therapy Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D98 - D100. [Abstract] [Full Text] [PDF]
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L. A. Nikolaidis, D. Trumble, T. Hentosz, A. Doverspike, R. Huerbin, M. A. Mathier, Y.-T. Shen, and R. P. Shannon Catecholamines restore myocardial contractility in dilated cardiomyopathy at the expense of increased coronary blood flow and myocardial oxygen consumption (MvO2 cost of catecholamines in heart failure) Eur J Heart Fail, June 1, 2004; 6(4): 409 - 419. [Abstract] [Full Text] [PDF]
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M. R. Bristow, L. A. Saxon, J. Boehmer, S. Krueger, D. A. Kass, T. De Marco, P. Carson, L. DiCarlo, D. DeMets, B. G. White, et al. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure N. Engl. J. Med., May 20, 2004; 350(21): 2140 - 2150. [Abstract] [Full Text] [PDF]
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P D. Bella and C Carbucicchio Non-contact left ventricular endocardial mapping for cardiac resynchronisation therapy: a "slow conduction" towards the fast solution Heart, May 1, 2004; 90(5): 483 - 484. [Abstract] [Full Text] [PDF]
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J. J. M. Zwanenburg, M. J. W. Gotte, J. P. A. Kuijer, R. M. Heethaar, A. C. van Rossum, and J. T. Marcus Timing of cardiac contraction in humans mapped by high-temporal-resolution MRI tagging: early onset and late peak of shortening in lateral wall Am J Physiol Heart Circ Physiol, May 1, 2004; 286(5): H1872 - H1880. [Abstract] [Full Text] [PDF]
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J.-J. Blanc, V. Bertault-Valls, M. Fatemi, M. Gilard, P.-Y. Pennec, and Y. Etienne Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure Circulation, April 13, 2004; 109(14): 1741 - 1744. [Abstract] [Full Text] [PDF]
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J. Sundell, E. Engblom, J. Koistinen, A. Ylitalo, A. Naum, K. Q. Stolen, R. Kalliokoski, S. G. Nekolla, K. E. J. Airaksinen, J. J. Bax, et al. The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1027 - 1033. [Abstract] [Full Text] [PDF]
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C. Leclercq and J. M. Hare Ventricular Resynchronization: Current State of the Art Circulation, January 27, 2004; 109(3): 296 - 299. [Full Text] [PDF]
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H. Bader, S. Garrigue, S. Lafitte, S. Reuter, P. Jais, M. Haissaguerre, J. Bonnet, J. Clementy, and R. Roudaut Intra-left ventricular electromechanical asynchrony: A new independent predictor of severe cardiac events in heart failure patients J. Am. Coll. Cardiol., January 21, 2004; 43(2): 248 - 256. [Abstract] [Full Text] [PDF]
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V.ér. Valls-Bertault, M. Fatemi, M. Gilard, P. Y. Pennec, Y. Etienne, and J.-J. Blanc Assessment of upgrading to biventricular pacing in patients with right ventricular pacing and congestive heart failure after atrioventricular junctional ablation for chronic atrial fibrillation Europace, January 1, 2004; 6(5): 438 - 443. [Abstract] [Full Text] [PDF]
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P D Lambiase, A Rinaldi, J Hauck, M Mobb, D Elliott, S Mohammad, J S Gill, and C A Bucknall Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy Heart, January 1, 2004; 90(1): 44 - 51. [Abstract] [Full Text] [PDF]
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A. Auricchio, C. Stellbrink, C. Butter, S. Sack, J. Vogt, A. R. Misier, D. Bocker, M. Block, J. H. Kirkels, Pacing Therapies in Congestive Heart Failure (PATH, et al. Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2109 - 2116. [Abstract] [Full Text] [PDF]
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D. A. Kass Predicting cardiac resynchronization response by qrs duration: The long and short of it J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2125 - 2127. [Full Text] [PDF]
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Y. Yu, A. Kramer, J. Spinelli, J. Ding, W. Hoersch, and A. Auricchio Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2788 - H2796. [Abstract] [Full Text] [PDF]
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L. A. Saxon and K. A. Ellenbogen Resynchronization Therapy for the Treatment of Heart Failure Circulation, September 2, 2003; 108(9): 1044 - 1048. [Full Text] [PDF]
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O.-A. Breithardt, C. Stellbrink, L. Herbots, P. Claus, A. M. Sinha, B. Bijnens, P. Hanrath, and G. R. Sutherland Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block J. Am. Coll. Cardiol., August 6, 2003; 42(3): 486 - 494. [Abstract] [Full Text] [PDF]
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X. A. A. M. Verbeek, K. Vernooy, M. Peschar, R. N. M. Cornelussen, and F. W. Prinzen Intra-ventricular resynchronization for optimal left ventricular function during pacing in experimental left bundle branch block J. Am. Coll. Cardiol., August 6, 2003; 42(3): 558 - 567. [Abstract] [Full Text] [PDF]
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P Schuster, S Faerestrand, and O-J Ohm Colour tissue velocity imaging can show resynchronisation of longitudinal left ventricular contraction pattern by biventricular pacing in patients with severe heart failure Heart, August 1, 2003; 89(8): 859 - 864. [Abstract] [Full Text] [PDF]
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