on March 31, 2003
Circulation. 2003
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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Submitted on December 23, 2002
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.). * To whom correspondence should be addressed. 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. 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.
Accepted on February 7, 2003
Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure
Martin G. St John Sutton MD*,
-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.
Key words: heart failure • echocardiography • remodeling • pacing
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M. J. Haykowsky, Y. Liang, D. Pechter, L. W. Jones, F. A. McAlister, and A. M. Clark A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients: The Benefit Depends on the Type of Training Performed J. Am. Coll. Cardiol., June 19, 2007; 49(24): 2329 - 2336. [Abstract] [Full Text] [PDF]
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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]
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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]
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R. K. Rao, U. N. Kumar, J. Schafer, E. Viloria, D. De Lurgio, and E. Foster Reduced Ventricular Volumes and Improved Systolic Function With Cardiac Resynchronization Therapy: A Randomized Trial Comparing Simultaneous Biventricular Pacing, Sequential Biventricular Pacing, and Left Ventricular Pacing Circulation, April 24, 2007; 115(16): 2136 - 2144. [Abstract] [Full Text] [PDF]
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 B. Lichodziejewska, K. Kurnicka, K. Grudzka, J. Malysz, M. Ciurzynski, and D. Liszewska-Pfejfer Chronic and Acute Effects of Smoking on Left and Right Ventricular Relaxation in Young Healthy Smokers Chest, April 1, 2007; 131(4): 1142 - 1148. [Abstract] [Full Text] [PDF]
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P. J. Hauptman and H. N. Sabbah Reversal of ventricular remodeling: Important to establish and difficult to define Eur J Heart Fail, April 1, 2007; 9(4): 325 - 328. [Full Text] [PDF]
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M. Kubanek, I. Malek, J. Bytesnik, P. Fridl, L. Riedlbauchova, L. Karasova, V. Lanska, and J. Kautzner Decrease in plasma B-type natriuretic peptide early after initiation of cardiac resynchronization therapy predicts clinical improvement at 12 months Eur J Heart Fail, December 1, 2006; 8(8): 832 - 840. [Abstract] [Full Text] [PDF]
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M. R. Bristow Cardiac resynchronization therapy and adrenergic mechanisms Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2590 - H2591. [Full Text] [PDF]
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G. B. Bleeker, E. R. Holman, P. Steendijk, E. Boersma, E. E. van der Wall, M. J. Schalij, and J. J. Bax Cardiac Resynchronization Therapy in Patients With a Narrow QRS Complex J. Am. Coll. Cardiol., November 8, 2006; (2006) j.jacc.2006.07.067v1. [Abstract] [Full Text] [PDF]
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M. Rivero-Ayerza, D. A.M.J. Theuns, H. M. Garcia-Garcia, E. Boersma, M. Simoons, and L. J. Jordaens Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials Eur. Heart J., November 2, 2006; 27(22): 2682 - 2688. [Abstract] [Full Text] [PDF]
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 K. Thompson, G. Saab, D. Birnie, B. J.W. Chow, H. Ukkonen, K. Ananthasubramaniam, R. A. deKemp, L. Garrard, T. D. Ruddy, J. N. DaSilva, et al. Is Septal Glucose Metabolism Altered in Patients with Left Bundle Branch Block and Ischemic Cardiomyopathy? J. Nucl. Med., November 1, 2006; 47(11): 1763 - 1768. [Abstract] [Full Text] [PDF]
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 M. Toyama, A. Usui, T. Abe, H. Oshima, T. Akita, and Y. Ueda Mitral Valve Surgery for Dilated Cardiomyopathy with Mitral Regurgitation Asian Cardiovasc Thorac Ann, October 1, 2006; 14(5): 371 - 376. [Abstract] [Full Text] [PDF]
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A. Rubaj, P. Rucinski, K. Rejdak, K. Oleszczak, D. Duma, P. Grieb, and A. Kutarski Biventricular versus right ventricular pacing decreases immune activation and augments nitric oxide production in patients with chronic heart failure Eur J Heart Fail, October 1, 2006; 8(6): 615 - 620. [Abstract] [Full Text] [PDF]
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