title: Reverse ventricular remodeling and improved functional capacity after ventricular resynchronization in advanced heart failure.
abstract: BACKGROUND
  Ventricular resynchronization is a non-pharmacological treatment for advanced heart failure refractory to drug therapy and with intraventricular conduction delay. We describe the time course of echocardiographic and functional recovery after resynchronization in 31 patients (mean age 67 +/- 8 years).
  
  
  METHODS
  We evaluated NYHA class, echocardiogram, respiratory function, and cardiopulmonary test before pacemaker implantation (baseline), after 1-3 months (short-term evaluation), and 10-15 months afterwards (long-term evaluation, n = 21 patients). Mortality at 1 year was considered.
  
  
  RESULTS
  Both at short and long-term, patients improved NYHA class, ventricular function, and ventricular volumes. Already at short-term, we observed an increase in oxygen consumption at peak exercise (12.6 +/- 0.6 vs 10.5 +/- 0.5 ml/kg/min), oxygen consumption at anaerobic threshold (9.8 +/- 0.6 vs 8.3 +/- 0.6 ml/kg/min) and oxygen pulse (8.3 +/- 0.5 vs 7.5 +/- 0.5 ml/beat). Ventilatory efficacy (VE/VCO2 slope) and alveolo-capillary diffusion (estimated by the measurement of lung diffusion capacity for carbon monoxide - DLCO) improved only at long-term (VE/VCO2: 40.7 +/- 1.6 vs 45.3 +/- 1.8; DLCO: 70.3 +/- 2.7 vs 59.4 +/- 5.9% of predicted, p = 0.05). The 1-year mortality was 9.7%.
  
  
  CONCLUSIONS
  Ventricular resynchronization is linked to a fast and prolonged recovery of NYHA class, echocardiographic variables and stress tolerance. The improvement of indexes known to carry a prognostic value confirms that ventricular resynchronization can positively interfere with the evolution of the disease.
authors.affiliation: Division of Cardiology, Istituto Scientifico Ospedale San Luca, Milan, Italy. Malfi@Auxologico.it
authors.forename: Gabriella
authors.initials: G
authors.lastname: Malfatto
authors.forename: Mario
authors.initials: M
authors.lastname: Facchini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Branzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Brambilla
authors.forename: Gerardina
authors.initials: G
authors.lastname: Fratianni
authors.forename: Elena
authors.initials: E
authors.lastname: Tortorici
authors.forename: Eva
authors.initials: E
authors.lastname: Balla
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Perego
mesh_terms: D000368:Aged; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D020127:Recovery of Function; D014463:Ultrasonography