Circulation. 2003;107:1985-1990
Published online before print March 31, 2003, doi: 10.1161/01.CIR.0000065226.24159.E9
Published online before print March 31, 2003, doi: 10.1161/01.CIR.0000065226.24159.E9
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(Circulation. 2003;107:1985.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure
From the University of Pennsylvania Medical Center, Philadelphia, Pa (M.G.S.J.S., T.P., E.L., D.Z.K.); the University of Kentucky College of Medicine, Lexington, Ky (W.T.A., W.G.F.); Emory University/Crawford Long Hospital, Atlanta, Ga (A.L.S., D.B.D., A.R.L.); Long Beach Memorial Medical Center, Long Beach, Calif (M.E., J.M.); and Medtronic, Inc, Minneapolis, Minn (K.K., K.E.H., M.R.S.H.).
Correspondence to Martin St John Sutton, MD, Division of Cardiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104. E-mail suttonm{at}mail.med.upenn.edu
Background— Cardiac resynchronization therapy (CRT) has recently emerged as an effective treatment for patients with moderate to severe systolic heart failure and ventricular dyssynchrony. The purpose of the present study was to determine whether improvements in left ventricular (LV) size and function were associated with CRT.
Methods and Results— Doppler echocardiograms were obtained at baseline and at 3 and 6 months after therapy in 323 patients enrolled in the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial. Of these, 172 patients were randomized to CRT on and 151 patients to CRT off. Measurements were made of LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, severity of mitral regurgitation (MR), peak transmitral velocities during early (E-wave) and late (A-wave) diastolic filling, and the myocardial performance index. At 6 months, CRT was associated with reduced end-diastolic and end-systolic volumes (both P<0.001), reduced LV mass (P<0.01), increased ejection fraction (P<0.001), reduced MR (P<0.001), and improved myocardial performance index (P<0.001) compared with control. ß-Blocker treatment status did not influence the effect of CRT. Improvements with CRT were greater in patients with a nonischemic versus ischemic cause of heart failure.
Conclusions— CRT in patients with moderate-to-severe heart failure who were treated with optimal medical therapy is associated with reverse LV remodeling, improved systolic and diastolic function, and decreased MR. LV remodeling likely contributes to the symptomatic benefits of CRT and may herald improved longer-term survival.
Key Words: heart failure • echocardiography • remodeling • pacing
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R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
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R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
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M. V. Pitzalis, M. Iacoviello, F. Di Serio, R. Romito, P. Guida, E. De Tommasi, G. Luzzi, M. Anaclerio, L. Varraso, C. Forleo, et al. Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy Eur J Heart Fail, August 1, 2006; 8(5): 509 - 514. [Abstract] [Full Text] [PDF]
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J. A. Jarcho Biventricular pacing. N. Engl. J. Med., July 20, 2006; 355(3): 288 - 294. [Full Text] [PDF]
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E. Zima, M. Lippert, G. Czygan, and B. Merkely Determination of left ventricular volume changes by intracardiac conductance using a biventricular electrode configuration Europace, July 1, 2006; 8(7): 537 - 544. [Abstract] [Full Text] [PDF]
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L. R. Goldberg and M. Jessup Stage B Heart Failure: Management of Asymptomatic Left Ventricular Systolic Dysfunction Circulation, June 20, 2006; 113(24): 2851 - 2860. [Full Text] [PDF]
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Q. Zhang, J. W.-H. Fung, A. Auricchio, J. Y.-S. Chan, L. C.C. Kum, L. W. Wu, and C.-M. Yu Differential change in left ventricular mass and regional wall thickness after cardiac resynchronization therapy for heart failure Eur. Heart J., June 2, 2006; 27(12): 1423 - 1430. [Abstract] [Full Text] [PDF]
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H. Mannaerts Regression of left ventricular mass and wall thickness after cardiac resynchronization therapy: proof of pathophysiological concept Eur. Heart J., June 2, 2006; 27(12): 1392 - 1393. [Full Text] [PDF]
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N. M. Hawkins, M. C. Petrie, M. R. MacDonald, K. J. Hogg, and J. J.V. McMurray Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony? Eur. Heart J., June 1, 2006; 27(11): 1270 - 1281. [Abstract] [Full Text] [PDF]
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E. Donal, C. Leclercq, C. Linde, and J.-C. Daubert Effects of cardiac resynchronization therapy on disease progression in chronic heart failure Eur. Heart J., May 1, 2006; 27(9): 1018 - 1025. [Abstract] [Full Text] [PDF]
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P. Steendijk, S. A. Tulner, J. J. Bax, P. V. Oemrawsingh, G. B. Bleeker, L. van Erven, H. Putter, H. F. Verwey, E. E. van der Wall, and M. J. Schalij Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy: Analysis by Pressure-Volume Loops Circulation, March 14, 2006; 113(10): 1295 - 1304. [Abstract] [Full Text] [PDF]
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O. Lindner, J. Sorensen, J. Vogt, E. Fricke, D. Baller, D. Horstkotte, and W. Burchert Cardiac Efficiency and Oxygen Consumption Measured with 11C-Acetate PET After Long-Term Cardiac Resynchronization Therapy J. Nucl. Med., March 1, 2006; 47(3): 378 - 383. [Abstract] [Full Text] [PDF]
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G. B. Bleeker, T. A.M. Kaandorp, H. J. Lamb, E. Boersma, P. Steendijk, A. de Roos, E. E. van der Wall, M. J. Schalij, and J. J. Bax Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy Circulation, February 21, 2006; 113(7): 969 - 976. [Abstract] [Full Text] [PDF]
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M. S. Suffoletto, K. Dohi, M. Cannesson, S. Saba, and J. Gorcsan III Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy Circulation, February 21, 2006; 113(7): 960 - 968. [Abstract] [Full Text] [PDF]
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D. Vollmann, L. Luthje, P. Schott, G. Hasenfuss, and C. Unterberg-Buchwald Biventricular Pacing Improves the Blunted Force-Frequency Relation Present During Univentricular Pacing in Patients With Heart Failure and Conduction Delay Circulation, February 21, 2006; 113(7): 953 - 959. [Abstract] [Full Text] [PDF]
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M. G. St John Sutton, T. Plappert, K. E. Hilpisch, W. T. Abraham, D. L. Hayes, and E. Chinchoy Sustained Reverse Left Ventricular Structural Remodeling With Cardiac Resynchronization at One Year Is a Function of Etiology: Quantitative Doppler Echocardiographic Evidence From the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Circulation, January 17, 2006; 113(2): 266 - 272. [Abstract] [Full Text] [PDF]
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R. R. Brandt, C. Reiner, R. Arnold, J. Sperzel, H. F. Pitschner, and C. W. Hamm Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy Eur. Heart J., January 2, 2006; 27(2): 187 - 192. [Abstract] [Full Text] [PDF]
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C. Leclercq, G. Ansalone, F. Gadler, G. Boriani, N. Perez-Castellano, N. Grubb, S. Sack, and E. Boulogne Biventricular vs. left univentricular pacing in heart failure: rationale, design, and endpoints of the B-LEFT HF study. Europace, January 1, 2006; 8(1): 76 - 80. [Abstract] [Full Text] [PDF]
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M. C. Porciani, R. Macioce, G. Demarchi, M. Chiostri, N. Musilli, F. Cappelli, A. Lilli, G. Ricciardi, and L. Padeletti Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure Eur J Echocardiogr, January 1, 2006; 7(1): 31 - 39. [Abstract] [Full Text] [PDF]
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J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al. Cardiac Resynchronization Therapy: Part 2--Issues During and After Device Implantation and Unresolved Questions J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2168 - 2182. [Abstract] [Full Text] [PDF]
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J. M. Aranda Jr, G. W. Woo, R. S. Schofield, E. M. Handberg, J. A. Hill, A. B. Curtis, S. F. Sears, J. S. Goff, D. F. Pauly, and J. B. Conti Management of Heart Failure After Cardiac Resynchronization Therapy: Integrating Advanced Heart Failure Treatment With Optimal Device Function J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2193 - 2198. [Abstract] [Full Text] [PDF]
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J. C. Daubert, C. Leclercq, and P. Mabo There Is Plenty of Room for Cardiac Resynchronization Therapy Devices Without Back-Up Defibrillators in the Electrical Treatment of Heart Failure J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2204 - 2207. [Abstract] [Full Text] [PDF]
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