Circulation. 2002;106:2078-2084
Published online before print September 30, 2002, doi: 10.1161/01.CIR.0000034512.90874.8E
Published online before print September 30, 2002, doi: 10.1161/01.CIR.0000034512.90874.8E
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(Circulation. 2002;106:2078.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Sequential Versus Simultaneous Biventricular Resynchronization for Severe Heart Failure
Evaluation by Tissue Doppler Imaging
From the Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark.
Correspondence to Peter Sogaard, MD, DMSc, Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, DK 8200 Aarhus N, Denmark. E-mail psogaard{at}dadlnet.dk
Background— Cardiac resynchronization therapy (CRT) by means of simultaneous biventricular pacing improves left ventricular systolic performance and synchrony in patients with heart failure and bundle-branch block. We used tissue tracking and 3D echocardiography to evaluate the impact of sequential CRT with individualized interventricular delay programming.
Methods and Results— Twenty consecutive patients with severe heart failure and left bundle-branch block were included. Tissue tracking and 3D echocardiography were carried out before and on the day after pacemaker implantation. Eleven different interventricular delays were examined in each patient. Patients were reexamined after 3 months. Simultaneous CRT immediately reduced the extent of myocardium displaying delayed longitudinal contraction (DLC) from 48.6±16% to 23.2±13% (P<0.01) and increased left ventricular ejection fraction percentage (LVEF%) from 22.4±6% to 29.7±5% (P<0.01). However, optimum sequential CRT caused a further reduction in the extent of DLC from 23.2±13% to 11.1±7.2% (P<0.01), with a simultaneous increase in LVEF% (from 29.7±5% to 33.9±6%, P<0.01). Three months of optimum sequential CRT further improved LVEF% (from 33.6±6% to 38.6±7.2%, P<0.01). Tissue tracking detected the segments with DLC, and their location determined optimum interventricular delay programming. Compared with simultaneous CRT, sequential CRT increased diastolic filling time by 7±2.5%.
Conclusions— Compared with simultaneous CRT, sequential CRT significantly improves left ventricular systolic and diastolic performance. Tissue tracking can be used to select optimum interventricular delay during CRT.
Key Words: imaging • echocardiography • heart failure • bundle-branch block • pacing
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P. Steendijk, S. A. F. Tulner, J. J. Schreuder, J. J. Bax, L. van Erven, E. E. van der Wall, R. A. E. Dion, M. J. Schalij, and J. Baan Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H723 - H730. [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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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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W. T. Abraham and D. L. Hayes Cardiac Resynchronization Therapy for Heart Failure Circulation, November 25, 2003; 108(21): 2596 - 2603. [Full Text] [PDF]
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J. K. Oh and J. Tajik The return of cardiac time intervals: The Phoenix is rising J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1471 - 1474. [Full Text] [PDF]
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O.-A. Breithardt, C. Stellbrink, M. G. St John Sutton, T. Plappert, W. T. Abraham, A. L. Smith, D. B. DeLurgio, A. R. Leon, E. Loh, D. Z. Kocovic, et al. Cardiac Resynchronization Therapy * Response Circulation, September 30, 2003; 108 (13): e97 - e97. [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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E. I. Skalidis, P. E. Vardas, H. Ukkonen, R. S.B. Beanlands, I. Burwash, R. A. de Kemp, A. S.L. Tang, C. Nahmias, E. Fallen, and M. R.S. Hill Cardiac Resynchronization and Myocardial Oxidative Metabolism * Response Circulation, June 24, 2003; 107 (24): e220 - e220. [Full Text] [PDF]
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