title: Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome.
abstract: OBJECTIVE
  Although acute haemodynamic improvement in response to cardiac resynchronization therapy (CRT) is reflective of a favourable cardiac contractile response, there is limited information regarding not only its ability to predict long-term clinical outcome but also cardiac-substrate-specific differences in the prognostic value of this measure.
  
  
  RESULTS
  Fifty-three heart failure patients (69 +/- 11 years) with low left ventricle ejection fraction (LVEF) (22 +/- 6%), wide QRS (169 +/- 31 ms), and indications for CRT were included. There were no significant differences in age, New York Heart Association (NYHA) class, medications, QRS width, or LVEF between ischaemic (n = 37) and non-ischaemic (n = 16) groups. Echocardiograms were performed within 24 h of implantation with device OFF and ON. Acute haemodynamic response was measured as LV dP/dt derived from the CW Doppler of mitral regurgitation. Percentage change in dP/dt was used to classify patients: high- (HR: DeltadP/dt > 25%) or poor-responders (PR: DeltadP/dt <or= 25%). Clinical response to CRT was defined by a combined endpoint of hospitalizations and all-cause mortality at 12 months. HR group had a significantly better outcome compared to the PR group (P-value = 0.004) irrespective of the aetiology of the cardiomyopathy.
  
  
  CONCLUSIONS
  Echocardiographic assessment of the acute haemodynamic response to CRT predicts long-term clinical outcome in both ischaemic and non-ischaemic cardiomyopathy.
authors: Cardiac Arrhythmia Service and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors: Francois B
authors: FB
authors: Tournoux
authors: Chrisfouad
authors: C
authors: Alabiad
authors: Dali
authors: D
authors: Fan
authors: Annabel A
authors: AA
authors: Chen
authors: Miguel
authors: M
authors: Chaput
authors: Edwin Kevin
authors: EK
authors: Heist
authors: Theofanie
authors: T
authors: Mela
authors: Moussa
authors: M
authors: Mansour
authors: Vivek
authors: V
authors: Reddy
authors: Jeremy N
authors: JN
authors: Ruskin
authors: Michael H
authors: MH
authors: Picard
authors: Jagmeet P
authors: JP
authors: Singh
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy*