Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome.
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.
Tournoux
Francois B
FB
Cardiac Arrhythmia Service and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Alabiad
Chrisfouad
C
Fan
Dali
D
Chen
Annabel A
AA
Chaput
Miguel
M
Heist
Edwin Kevin
EK
Mela
Theofanie
T
Mansour
Moussa
M
Reddy
Vivek
V
Ruskin
Jeremy N
JN
Picard
Michael H
MH
Singh
Jagmeet P
JP
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*