Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy.
BACKGROUND
Cardiac resynchronization therapy (CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern (LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT.


METHODS
65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP (RFP) was present in 25 patients, whereas 40 patients showed no-RFP.


RESULTS
After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio (E/A) increased from 0.8+/-0.3 to 1.0+/-0.6 (p=0.006) and E wave deceleration time (DT) decreased from 234+/-83 ms to 196+/-51 ms (p=0.028). In 13 RFP patients, E/A decreased from 2.2+/-0.9 to 0.8+/-0.5 and DT increased from 128+/-43 ms to 205+/-52 ms (both p<0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5% (2/40) and 15% (2/13) respectively. The remaining patients showed persistence of RFP (E/A and DT unchanged), no improvement and a mortality rate of 42% (5/12) (p=0.005, versus no-RFP).


CONCLUSIONS
CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.
Porciani
Maria Cristina
MC
Institute of Internal Medicine and Cardiology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
Valsecchi
Sergio
S
Demarchi
Gabriele
G
Colella
Andrea
A
Michelucci
Antonio
A
Pieragnoli
Paolo
P
Musilli
Nicola
N
Gensini
Gian Franco
GF
Padeletti
Luigi
L
D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D015897:Comorbidity; D003971:Diastole / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*