title: Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony.
abstract: OBJECTIVE
  The value of interventricular and intraventricular echocardiographic asynchrony parameters in predicting reverse remodeling after cardiac resynchronization therapy (CRT) was investigated.
  
  
  BACKGROUND
  Cardiac resynchronization therapy has been suggested as a promising strategy in patients with severe heart failure and left bundle branch block (LBBB), but the entity of benefit is variable and no criteria are yet available to predict which patients will gain.
  
  
  METHODS
  Interventricular and intraventricular mechanical asynchrony was evaluated in 20 patients (8 men and 12 women, 63 +/- 10 years) with advanced heart failure caused by ischemic (n = 4) or nonischemic dilated cardiomyopathy (n = 16) and LBBB (QRS duration of at least 140 ms) using echocardiographic Doppler measurements. Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were calculated before and one month after CRT. Patients with a LVESVI reduction of at least 15% were considered as responders.
  
  
  RESULTS
  Cardiac resynchronization therapy significantly improved ventricular volumes (LVEDVI from 150 +/- 53 ml/m(2) to 119 +/- 37 ml/m(2), p < 0.001; LVESVI from 116 +/- 43 ml/m(2) to 85 +/- 29 ml/m(2), p < 0.0001). At baseline, the responders had a significantly longer septal-to-posterior wall motion delay (SPWMD), a left intraventricular asynchrony parameter; only QRS duration and SPWMD significantly correlated with a reduction in LVESVI (r = -0.54, p < 0.05 and r = -0.70, p < 0.001, respectively), but the accuracy of SPWMD in predicting reverse remodeling was greater than that of the QRS duration (85% vs. 65%).
  
  
  CONCLUSIONS
  In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.
authors.affiliation: Institute of Cardiology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy. mariavittoria.pitzalis@cardio.unibas.it
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Pitzalis
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Roberta
authors.initials: R
authors.lastname: Romito
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.forename: Brian
authors.initials: B
authors.lastname: Rizzon
authors.forename: Giovanni
authors.initials: G
authors.lastname: Luzzi
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Andrea
authors.initials: A
authors.lastname: Andriani
authors.forename: Filippo
authors.initials: F
authors.lastname: Mastropasqua
authors.forename: Paolo
authors.initials: P
authors.lastname: Rizzon
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*