title: Improvements in left ventricular diastolic function after cardiac resynchronization therapy are coupled to response in systolic performance.
abstract: 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.
authors.affiliation: Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA. waggonera@msnotes.wustl.edu
authors.forename: Alan D
authors.initials: AD
authors.lastname: Waggoner
authors.forename: Mitchell N
authors.initials: MN
authors.lastname: Faddis
authors.forename: Marye J
authors.initials: MJ
authors.lastname: Gleva
authors.forename: Lisa
authors.initials: L
authors.lastname: de las Fuentes
authors.forename: Víctor G
authors.initials: VG
authors.lastname: Dávila-Román
mesh_terms: 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