Improvement in diastolic function and left ventricular filling pressure induced by cardiac resynchronization therapy.
BACKGROUND
Variable results of cardiac resynchronization therapy (CRT) on diastolic function have been described. We investigated 3 and 12 months' effect of CRT on diastolic function and left ventricular (LV) filling pressures and their relation to LV reverse remodeling.


METHODS
Fifty-two patients' (36 male, 69 +/- 8 years, QRS duration 170 +/- 29 milliseconds) echo-Doppler was performed before and 3 and 12 months after CRT. Tissue Doppler early diastolic annular (Em) and color M-mode-derived flow propagation (Vp) velocities were used to estimate LV filling pressures by E/Em and E/Vp ratios.


RESULTS
After 12 months, LV reverse remodeling (end-systolic volume decrease >15%) was observed in 58%. Despite a significantly more compromised baseline diastolic function of patients without LV reverse remodeling, multivariate analysis revealed that only LV dyssynchrony could predict LV reverse remodeling. Grades 2 and 3 diastolic function improved only in LV reverse remodeling patients (from 34% to 13% to 10%), whereas a nonsignificant increase from 59% to 67% to 72% was observed in patients without reverse remodeling. Irrespective of LV volume response, short-term symptomatic benefit was related to decreased filling pressure. However, after 12 months, E/Em and E/Vp only significantly decreased in patients with LV reverse remodeling (from 16.0 +/- 6 to 10.4 +/- 4 and 2.2 +/- 0.6 to 1.5 +/- 0.4, respectively).


CONCLUSIONS
Left ventricular reverse remodeling induced by CRT is accompanied by improvement in diastolic function and estimated LV filling pressure. Short-term symptomatic benefit was related to decreased filling pressure. However, for longer-term symptomatic improvement and decreased filling pressures, LV reverse remodeling appeared mandatory.
Jansen
Annemieke H M
AH
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. annemieke.jansen@cze.nl
van Dantzig
Jan melle
Jm
Bracke
Frank
F
Peels
Kathinka H
KH
Koolen
Jacques J
JJ
Meijer
Albert
A
de Vries
Jolanda
J
Korsten
Hendrikus
H
van Hemel
Norbert M
NM
D000368:Aged; D002304:Cardiac Pacing, Artificial; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017725:Ventricular Pressure; D020257:Ventricular Remodeling