title: Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure.
abstract: OBJECTIVE
  To quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.
  
  
  METHODS
  Three dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2-7 days) biventricular pacing.
  
  
  RESULTS
  Compared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r(2) = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %DeltaEDV, %DeltaESV, and %DeltaFSV.
  
  
  CONCLUSIONS
  In five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.
authors: Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark. skejyk@aau.dk
authors: W Y
authors: WY
authors: Kim
authors: P
authors: P
authors: Søgaard
authors: P T
authors: PT
authors: Mortensen
authors: H K
authors: HK
authors: Jensen
authors: A K
authors: AK
authors: Pedersen
authors: B O
authors: BO
authors: Kristensen
authors: H
authors: H
authors: Egeblad
mesh_terms: D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005080:Exercise Test; D005240:Feasibility Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000628:therapy; D012044:Regression Analysis; D013318:Stroke Volume; D016138:Walking / Q000502:physiology