title: Basal asynchrony and resynchronization with biventricular pacing predict long-term improvement of LV function in heart failure patients.
abstract: Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long-term evolution of ventricular function after BiV. Thirty-four patients (NYHA Class III-IV,65.4 +/- 11 years) with large QRS(179 +/- 18 ms)were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow-up(20 +/- 7 months). We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from 20.2 +/- 8.1%(D0) to27.1%+/- 12.6%(follow-up,P < 0.003 vs D0) and RVEF from 28.6%+/- 13%(D0) to 34.3 +/- 11.5%(follow-up,P < 0.03 vs D0). Inter- (DeltaTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from 68.3 +/- 38 ms(D0) to 13.4 +/- 48.5 ms(D8) and1.8 +/- 39.2 ms(follow-up,P < 0.0001 vs D0); and Tab from 45.8 +/- 64.1 msto-18 +/- 68(D8) and-28.3 +/- 53.6 ms(follow-up,P < 0.0001 vs D0). Early inter- and intraventricular resynchronization (DeltaTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow-up. In DCM patients, BiV resynchronizes ventricles early and in the long-term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV.
authors.affiliation: Physiology & Radioisotopes Unit, Hôpital Européen Georges Pompidou, Paris, France. jean-francois.toussaint@egp.ap-hop-paris.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Toussaint
authors.forename: Thomas
authors.initials: T
authors.lastname: Lavergne
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Kerrou
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.forename: Jacky
authors.initials: J
authors.lastname: Ollitrault
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Darondel
authors.forename: Christine
authors.initials: C
authors.lastname: Alonso
authors.forename: Benoît
authors.initials: B
authors.lastname: Diebold
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.forename: Louis
authors.initials: L
authors.lastname: Guize
authors.forename: Michel
authors.initials: M
authors.lastname: Paillard
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*