Published online before print March 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.540435
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(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
Related Article:
-
Issue Highlights
Circulation 2006 113: 1271.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  F. Eberhardt, M. Heringlake, M. S. Massalme, A. Dyllus, M. Misfeld, H.-H. Sievers, U. K.H. Wiegand, and T. Hanke The effect of biventricular pacing after coronary artery bypass grafting: A prospective randomized trial of different pacing modes in patients with reduced left ventricular function. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1461 - 1467. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Zocalo, D. Bia, W. Reyes-Caorsi, J. Gonzalez-Moreno, and R. L. Armentano Arterial load reduction after cardiac resynchronization therapy: why does it change? Eur J Echocardiogr, June 1, 2009; 10(4): 461 - 462. [Full Text] [PDF]
|
|
|
|
|
|
F. Zanon, S. Aggio, and G. Corbucci Arterial load reduction after cardiac resynchronization therapy: why does it change?: reply Eur J Echocardiogr, June 1, 2009; 10(4): 462 - 463. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Laveneziana, D. E. O'Donnell, D. Ofir, P. Agostoni, L. Padeletti, G. Ricciardi, P. Palange, R. Duranti, and G. Scano Effect of biventricular pacing on ventilatory and perceptual responses to exercise in patients with stable chronic heart failure J Appl Physiol, May 1, 2009; 106(5): 1574 - 1583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Remmelink, K. D. Sjauw, J. P.S. Henriques, M. M. Vis, R. J. van der Schaaf, K. T. Koch, J. G.P. Tijssen, R. J. de Winter, J. J. Piek, and J. Baan Jr Acute left ventricular dynamic effects of primary percutaneous coronary intervention from occlusion to reperfusion. J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1498 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. P. H.M. Delnoy, J. P. Ottervanger, H. O. Luttikhuis, D. H.S. Vos, A. Elvan, A. R. Ramdat Misier, W. P. Beukema, P. Steendijk, and N. M. van Hemel Pressure-volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites Eur. Heart J., April 1, 2009; 30(7): 797 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Zanon, S. Aggio, E. Baracca, G. Pastore, G. Corbucci, G. Boaretto, G. Braggion, C. Piergentili, G. Rigatelli, and L. Roncon Ventricular-arterial coupling in patients with heart failure treated with cardiac resynchronization therapy: may we predict the long-term clinical response? Eur J Echocardiogr, January 1, 2009; 10(1): 106 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Lim, G. Y.H. Lip, and J. E. Sanderson Ventricular optimization of biventricular pacing: a systematic review Europace, July 8, 2008; (2008) eun177v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. O. Sweeney and F. W. Prinzen Ventricular Pump Function and Pacing: Physiological and Clinical Integration Circ Arrhythmia Electrophysiol, June 1, 2008; 1(2): 127 - 139. [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. ten Brinke, R. J. Klautz, S. A. Tulner, F. H. Engbers, H. F. Verwey, D. E. Atsma, M. J. Schalij, E. E. van der Wall, J. J. Bax, H. Putter, et al. Haemodynamics and left ventricular function in heart failure patients: Comparison of awake versus intra-operative conditions Eur J Heart Fail, May 1, 2008; 10(5): 467 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Westermann, M. Kasner, P. Steendijk, F. Spillmann, A. Riad, K. Weitmann, W. Hoffmann, W. Poller, M. Pauschinger, H.-P. Schultheiss, et al. Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction Circulation, April 22, 2008; 117(16): 2051 - 2060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Inage, T. Yoshida, T. Hiraki, M. Ohe, T. Takeuchi, Y. Nagamoto, Y. Fukuda, T. Gondo, and T. Imaizumi Chronic cardiac resynchronization therapy reverses cardiac remodelling and improves invasive haemodynamics of patients with severe heart failure on optimal medical treatment Europace, March 1, 2008; 10(3): 379 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Butter and G. Hindricks Cardiac resynchronization therapy: haemodynamic background and perspectives Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I87 - I93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Uebing, D. G. Gibson, S. V. Babu-Narayan, G. P. Diller, K. Dimopoulos, O. Goktekin, M. S. Spence, K. Andersen, M. Y. Henein, M. A. Gatzoulis, et al. Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot: Implications of Infundibular Disease Circulation, October 2, 2007; 116(14): 1532 - 1539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Vitarelli, P. Franciosa, and S. Rosanio Tissue Doppler Imaging in the assessment of selection and response from cardiac resynchronization therapy Eur J Echocardiogr, October 1, 2007; 8(5): 309 - 316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Page, S. Cazeau, P. Ritter, D. Galley, and C. Casset Physiological approach to monitor patients in congestive heart failure: application of a new implantable device-based system to monitor daily life activity and ventilation Europace, August 1, 2007; 9(8): 687 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Valzania, F. Gadler, M. J. Eriksson, A. Olsson, G. Boriani, and F. Braunschweig Electromechanical effects of cardiac resynchronization therapy during rest and stress in patients with heart failure Eur J Heart Fail, June 1, 2007; 9(6-7): 644 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. B. Tournoux, C. Alabiad, D. Fan, A. A. Chen, M. Chaput, E. K. Heist, T. Mela, M. Mansour, V. Reddy, J. N. Ruskin, et al. Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome Eur. Heart J., May 1, 2007; 28(9): 1143 - 1148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Burkhardt and B. L. Wilkoff Interventional Electrophysiology and Cardiac Resynchronization Therapy: Delivering Electrical Therapies for Heart Failure Circulation, April 24, 2007; 115(16): 2208 - 2220. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Quinn, G. Berberian, S. E. Cabreriza, L. J. Maskin, A. D. Weinberg, J. W. Holmes, and H. M. Spotnitz Effects of sequential biventricular pacing during acute right ventricular pressure overload Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2380 - H2387. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Knaapen, C. P. Allaart, C. C. de Cock, and J. G.F. Bronzwaer Letter by Knaapen et al Regarding Article, "Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy: Analysis by Pressure-Volume Loops" Circulation, August 29, 2006; 114(9): e371 - e371. [Full Text] [PDF]
|
|
|
|
|
|
P. Steendijk, S. A. Tulner, J. J. Bax, P. V. Oemrawsingh, G. B. Bleeker, L. van Erven, H. F. Verwey, E. E. van der Wall, M. J. Schalij, and H. Putter Response to Letter Regarding Article, "Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy: Analysis by Pressure-Volume Loops" Circulation, August 29, 2006; 114(9): e372 - e372. [Full Text] [PDF]
|
|