Abstract 20284: Diastolic Dysfunction may Cause Heart Failure Symptoms in Patients Hyperresponder to Cardiac Resynchronization Therapy
Introduction: Cardiac resynchronization therapy (CRT) decreases left ventricular end-systolic, end-diastolic volumes and improves systolic function, with restoration of normal left ventricular (LV) ejection fraction (EF) in approximately 10% of patients (hyperresponders). Diastolic function also improves in most patients responding to CRT. In our experience, heart failure symptoms persist in some patients despite normalization of LV systolic function.
Hypothesis: We assessed the hypothesis that heart failure symptoms in patients demonstrating normalization of systolic LV function in response to CRT might be attributed to diastolic dysfunction.
Methods: Symptoms and functional status of patients hyperresponder to CRT were evaluated by NYHA classification and 6-minute walk test. Left ventricular volumes, LV EF, left atrial volume and diastolic parameters (E, A, Ad, DT, e' lat., e' sept., IVRT, Flow propagation, S,D,Ar,Ard) were assessed by echocardiography. Pro-BNP, haemoglobin and renal function were also evaluated.
Results: A total of 27 patients (15 female, mean age: 61,6±9,7years) with a LV EF> 50 % were involved in our study including 14 with heart failure symptoms (NYHA II-III). Symptomatic patients had a significantly shorter 6-minute walking distance (329±30,8m vs. 498±24,1m; p=0,0018). An elevated left atrial filling pressure with a significantly higher pro-BNP level (498,8±162,5 vs. 97,2±56,1 pg/ml; p=0,0003) was found in 5 out of these 14 patients. Alternative etiology of symptoms (COPD, hypertension, obesity) was found in the rest of symptomatic patients.
Conclusions: Elevated left atrial filling pressure due to diastolic dysfunction was found in a significant proportion of patients with heart failure symptoms who were hyperresponder to CRT.
- © 2010 by American Heart Association, Inc.