Improvements in left ventricular diastolic function after cardiac resynchronization therapy are coupled to response in systolic performance.
OBJECTIVE
To determine the short-term effects of cardiac resynchronization therapy (CRT) on measurements of left ventricular (LV) diastolic function in patients with severe heart failure.


BACKGROUND
Cardiac resynchronization therapy improves systolic performance; however, the effects on diastolic function by load-dependent pulsed-wave Doppler transmitral indices has been variable.


METHODS
Fifty patients with severe heart failure were evaluated by two-dimensional Doppler echocardiography immediately prior to and 4 +/- 1 month after CRT. Measurements included LV volumes and ejection fraction (EF), pulsed-wave Doppler (PWD)-derived transmitral filling indices (E- and A-wave velocities, E/A ratio, deceleration time [DT], diastolic filling time [DFT], and isovolumic relaxation time). Tissue Doppler imaging was used for measurements of systolic and diastolic (Em) velocities at four mitral annular sites; mitral E-wave/Em ratio was calculated to estimate LV filling pressure. Color M-mode flow propagation velocities were also obtained.


RESULTS
After CRT, LV volumes decreased significantly (p < 0.001) and LVEF increased >5% in 28 of 50 patients (56%) and were accompanied by reduction in PWD mitral E-wave velocity and E/A ratio (both p < 0.01), increased DT and DFT (both p < 0.01), and lower filling pressures (i.e., E-wave/Em septal; p < 0.01). Patients with LVEF response < or =5% after CRT had no significant changes in measurements of diastolic function; LV relaxation (i.e., Em velocities) worsened in this group.


CONCLUSIONS
In heart failure patients receiving CRT, improvement in LV diastolic function is coupled to the improvement in LV systolic function.
Waggoner
Alan D
AD
Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA. waggonera@msnotes.wustl.edu
Faddis
Mitchell N
MN
Gleva
Marye J
MJ
de las Fuentes
Lisa
L
Dávila-Román
Víctor G
VG
D000368:Aged; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left