Published online before print March 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.540435
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(Circulation. 2006;113:1295-1304.)
© 2006 American Heart Association, Inc.
Heart Failure |
Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy
Analysis by Pressure-Volume Loops
From the Departments of Cardiology (P.S., S.A.T., J.J.B., P.V.O., G.B.B., L.v.E., H.F.V., E.E.v.d.W., M.J.S.) and Medical Statistics (H.P.), Leiden University Medical Center, Leiden, the Netherlands.
Correspondence to Paul Steendijk, PhD, Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail p.steendijk{at}lumc.nl
Received February 2, 2005; revision received December 28, 2005; accepted January 13, 2006.
Background— Acute hemodynamic effects of cardiac resynchronization therapy (CRT) were reported previously, but detailed invasive studies showing hemodynamic consequences of long-term CRT are not available.
Methods and Results— We studied 22 patients scheduled for implantation of a CRT device based on conventional criteria (New York Heart Association class III or IV, left ventricular [LV] ejection fraction <35%, left bundle-branch block, and QRS duration >120 ms). During diagnostic catheterization before CRT, we acquired pressure-volume loops using conductance catheters during atrial pacing at 80, 100, 120, and 140 bpm. Studies were repeated during biventricular pacing at the same heart rates after 6 months of CRT. Our data show a significant clinical benefit of CRT (New York Heart Association class change from 3.1±0.5 to 2.1±0.8; quality-of-life score change from 44±12 to 31±16; and 6-minute hall-walk distance increased from 260±149 to 396±129 m; all P<0.001), improved LV ejection fraction (from 29±10% to 40±13%, P<0.01), decreased end-diastolic pressure (from 18±8 to 13±6 mm Hg, P<0.05), and reverse remodeling (end-diastolic volume decreased from 257±67 to 205±54 mL, P<0.01). Previously reported acute improvements in LV function remained present at 6 months: dP/dtmax increased 18%, –dP/dtmin increased 13%, and stroke work increased 34% (all P<0.01). Effects of increased heart rate were improved toward more physiological responses for LV ejection fraction, cardiac output, and dP/dtmax. Moreover, our study showed improved ventricular-arterial coupling (69% increase, P<0.01) and improved mechanical efficiency (44% increase, P<0.01).
Conclusions— Hemodynamic improvements with CRT, previously shown in acute invasive studies, are maintained chronically. In addition, ventricular-arterial coupling, mechanical efficiency, and chronotropic responses are improved after 6 months of CRT. These findings may help to explain the improved functional status and exercise tolerance in patients treated with CRT.
CLINICAL PERSPECTIVE
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