Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure.
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.
Oguz
Enis
E
Siyami Ersek Cardiovascular and Thoracic Surgery Center, Cardiology Clinic, Istanbul, Turkey. enisoguz1@superonline.com
Dagdeviren
Bahadir
B
Bilsel
Tuba
T
Akdemir
Osman
O
Erdinler
Izzet
I
Akyol
Ahmet
A
Ulufer
Tanju
T
Tezel
Tuna
T
Gurkan
Kadir
K
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