This Article Full Text Full Text (PDF) All Versions of this Article: 116/13/1440    most recent CIRCULATIONAHA.106.677005v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bleeker, G. B. Articles by Bax, J. J. Search for Related Content PubMed PubMed Citation Articles by Bleeker, G. B. Articles by Bax, J. J. Pubmed/NCBI databases Medline Plus Health Information Heart Failure Related Collections Congestive Pacemaker Echocardiography

(Circulation. 2007;116:1440-1448.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy

Analysis in Patients With Echocardiographic Evidence of Left Ventricular Dyssynchrony at Baseline

Gabe B. Bleeker, MD, PhD; Sjoerd A. Mollema, MD; Eduard R. Holman, MD, PhD; Nico Van De Veire, MD; Claudia Ypenburg, MD; Eric Boersma, PhD; Ernst E. van der Wall, MD, PhD; Martin J. Schalij, MD, PhD; Jeroen J. Bax, MD, PhD

From the Department of Cardiology, Leiden University Medical Center, Leiden (G.B.B., S.A.M., E.R.H., N.V.D.V., C.Y., E.E.v.d.W., M.J.S., J.J.B.); Interuniversity Cardiology Institute Netherlands, Utrecht (G.B.B.); and Department of Epidemiology and Statistics, Erasmus University, Erasmus (E.B.), the Netherlands.

Correspondence to Gabe B. Bleeker, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail g.b.bleeker{at}lumc.nl

Received November 17, 2006; accepted July 16, 2007.

Background— Recent studies have demonstrated that a positive response to cardiac resynchronization therapy (CRT) is related to the presence of preimplantation left ventricular (LV) dyssynchrony. The time course and the extent of LV resynchronization after CRT implantation and their relationship to response are currently unknown.

Methods and Results— One hundred consecutive patients scheduled for implantation of a CRT device were prospectively included if they met the following criteria: New York Heart Association class III to IV, LV ejection fraction 35%, QRS duration >120 ms, and LV dyssynchrony (65 ms) on color-coded tissue Doppler imaging. Immediately after CRT implantation, LV dyssynchrony was reduced from 114±36 to 40±33 ms (P<0.001), which persisted at the 6-month follow-up (35±31 ms; P<0.001 versus baseline; P=0.14 versus immediately after implantation). At the 6-month follow-up, 85% of patients were classified as responders to CRT (defined as >10% reduction in LV end-systolic volume). Immediately after implantation, the responders to CRT demonstrated a significant reduction in LV dyssynchrony from 115±37 to 32±23 ms (P<0.001). The nonresponders, however, did not show a significant reduction in LV dyssynchrony (106±29 versus 79±44 ms; P=0.08). If the extent of acute LV resynchronization was <20%, response to CRT at the 6-month follow-up was never observed. Conversely, 93% of patients with LV resynchronization 20% responded to CRT.

Conclusions— LV resynchronization after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up in patients with echocardiographic evidence of LV dyssynchrony at baseline.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				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]

				C. Daubert, C. Leclercq, H. Miljoen, B. P. Paelinck, C. J. Vrints, J. F. Beshai, R. A. Grimm, and S. F. Nagueh Cardiac-Resynchronization Therapy N. Engl. J. Med., April 24, 2008; 358(17): 1865 - 1866. [Full Text] [PDF]

				L. J. Anderson, C. Miyazaki, G. R. Sutherland, and J. K. Oh Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy Circulation, April 15, 2008; 117(15): 2009 - 2023. [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1221 - 1229. [Full Text] [PDF]

				T. Z. Naqvi and M. Motallebi Letter by Naqvi and Motallebi Regarding Article, "Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy" Circulation, March 18, 2008; 117(11): e196 - e196. [Full Text] [PDF]

				G. B. Bleeker, S. A. Mollema, E. R. Holman, N. Van De Veire, C. Ypenburg, E. E. van der Wall, M. J. Schalij, J. J. Bax, and E. Boersma Response to Letter Regarding Article, "Left Ventricular Dyssynchrony Is Mandatory for Response to Cardiac Resynchronization Therapy" Circulation, March 18, 2008; 117(11): e197 - e197. [Full Text] [PDF]

				D. A. Kass Highlighting the R in CRT Circulation, September 25, 2007; 116(13): 1434 - 1436. [Full Text] [PDF]