Clinical predictors of marked improvement in left ventricular performance after cardiac resynchronization therapy in patients with chronic heart failure.
BACKGROUND
Previous studies have shown that cardiac resynchronization therapy (CRT) improves cardiac performance and decreases mortality and hospital admission rates. However, it is not yet clear which patients will benefit from the procedure the most. The purpose of the study was to identify the pre-implant characteristics that better predict which patients will have the best outcome after CRT.


METHODS
In this observational study, 156 patients were studied with echocardiography and a 6-minute walking test at baseline and 12 months after CRT.


RESULTS
After CRT, we observed an increase in left ventricular ejection fraction (+29.6%, P < .0001), a decrease in left ventricular end systolic volume (-26.4%, P < .0001), in the proportion of patients with grade 2-4 mitral regurgitation (from 47.1% to 34.0%, P = .002), and with NYHA functional class III-IV (from 83.2% to 11.6%, P < .0001), an increase in exercise tolerance (+31.1%, P < .0001). Sixty-two patients had a marked increase in left ventricular ejection fraction (> 10 units); the only independent predictor of a marked effect of CRT was the nonischemic etiology of heart failure. In patients with ischemic cardiomyopathy, the benefit on ejection fraction correlates inversely with the extension of the ischemic damage.


CONCLUSIONS
CRT improves left ventricular function and exercise tolerance in the long term. The nonischemic etiology of the cardiomyopathy is the only independent predictor of a marked effect of CRT; this is probably due to the absence of ischemic, nonviable scar tissue in these patients.
Mangiavacchi
Maurizio
M
Department of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. maurizio.mangiavacchi@humanitas.it
Gasparini
Maurizio
M
Faletra
Francesco
F
Klersy
Catherine
C
Morenghi
Emanuela
E
Galimberti
Paola
P
Genovese
Luca
L
Regoli
François
F
De Chiara
Francesca
F
Bragato
Renato
R
Andreuzzi
Bruno
B
Pini
Daniela
D
Gronda
Edoardo
E
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000503:physiopathology; D010101:Oxygen Consumption; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020257:Ventricular Remodeling
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors