title: Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure.
abstract: BACKGROUND
  Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy.
  
  
  OBJECTIVE
  To assess whether the long-term benefit could be predicted from the echocardiographic parameters.
  
  
  RESULTS
  Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n=11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n=5) failed to improve at follow-up (7.6+/-5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256+/-105 vs. 358+/-115, P=0.14 and 564+/-199 vs. 468+/-117, P=0.44, respectively), the QRS width (149+/-15 vs. 175+/-24 ms, P=0.05) and the dMR (343+/-70 vs. 443+/-49 ms, P=0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P=0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468+/-117 to 676+/-216 mmHg/s vs. from 564+/-199 to 483+/-94, P=0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness.
  
  
  CONCLUSIONS
  Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing.
authors.affiliation: Siyami Ersek Cardiovascular and Thoracic Surgery Center, Cardiology Clinic, Istanbul, Turkey. enisoguz1@superonline.com
authors.forename: Enis
authors.initials: E
authors.lastname: Oguz
authors.forename: Bahadir
authors.initials: B
authors.lastname: Dagdeviren
authors.forename: Tuba
authors.initials: T
authors.lastname: Bilsel
authors.forename: Osman
authors.initials: O
authors.lastname: Akdemir
authors.forename: Izzet
authors.initials: I
authors.lastname: Erdinler
authors.forename: Ahmet
authors.initials: A
authors.lastname: Akyol
authors.forename: Tanju
authors.initials: T
authors.lastname: Ulufer
authors.forename: Tuna
authors.initials: T
authors.lastname: Tezel
authors.forename: Kadir
authors.initials: K
authors.lastname: Gurkan
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome