title: The effect of cardiac resynchronization therapy on left ventricular diastolic function assessed with speckle-tracking echocardiography.
abstract: OBJECTIVE
  Changes in left ventricular (LV) diastolic function after cardiac resynchronization therapy (CRT) in relation to LV reverse remodelling and heart failure aetiology have not been extensively characterized. The aims of the study were to evaluate changes in LV diastolic function with speckle-tracking echocardiography in relation to: (i) cardiac resynchronization therapy response (LV remodelling) and (ii) heart failure aetiology.
  
  
  RESULTS
  A total of 192 heart failure patients undergoing CRT implantation were evaluated. Speckle-tracking echocardiography was performed before and 6 months after implantation and reliable analysis was obtained in 188 patients. Left ventricular diastolic function was assessed by measuring diastolic strain rate during the isovolumic relaxation period (SR(IVR)) and by calculating the ratio of peak transmitral E-wave to SR(IVR) (E/SR(IVR)). Changes in LV diastolic parameters were evaluated in responders and non-responders and in patients with ischaemic and non-ischaemic cardiomyopathy. Response to CRT was defined as ≥15% reduction in LV end-systolic volume at 6 months follow-up. One-hundred and nine patients (58%) were defined as responders. Significant improvements in LV diastolic performance were observed in responders with improvement in SR(IVR) (from 0.14 ± 0.08 to 0.18 ± 0.12 s(-1), P= 0.001) and E/SR(IVR) (from 834 ± 840 to 641 ± 612, P= 0.04). In addition, LV relaxation improved in patients with non-ischaemic aetiology (SR(IVR): from 0.15 ± 0.08 to 0.19 ± 0.13 s(-1), P= 0.004). In contrast, LV relaxation did not improve in non-responders and in patients with ischaemic heart disease.
  
  
  CONCLUSIONS
  Novel diastolic strain rate indices are useful for evaluating changes in LV diastolic function after CRT. Improvement in diastolic function was only observed in responders to CRT and patients with non-ischaemic aetiology.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.forename: M Louisa
authors.initials: ML
authors.lastname: Antoni
authors.forename: Ulas
authors.initials: U
authors.lastname: Hoke
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Lieselot
authors.initials: L
authors.lastname: van Erven
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020257:Ventricular Remodeling