title: Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study.
abstract: OBJECTIVE
  To understand whether patients with post-ischemic dilated cardiomyopathy and myocardial viability (MV) could benefit from cardiac resynchronization therapy (CRT) in terms of clinical, echocardiographic and neuro- hormonal parameters compared to patients without MV.
  
  
  METHODS
  One hundred and four consecutive patients were enrolled in a prospective observational cohort study. Using dobutamine stress echocardiography, 2 groups were identified: group A of 51 patients with MV and group B of 53 patients without MV. All patients were implanted with biventricular pacing devices combined with an internal cardioverter-defibrillator. Clinical, echocardiographic and neuro-hormonal parameters were evaluated at baseline and at six month follow-up. Analysis of variance for repeated measures on each variable suggestive of remodeling was performed. We considered responder every patient with: decrease of > 15% in left ventricular volumes and/or improvement in left ventricular ejection fraction of > 5% in addition to NYHA class improvement.
  
  
  RESULTS
  All the variables improved in both groups (time effect). Comparing the two groups (group effect), the following variables were significantly better in group A: N-terminal pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic volume after the first week (p=0.035). RR occurred at the first week after CRT only in Group A and was maintained for all the time of this study. The maximum difference of the decrease of left ventricular volumes between the two groups occurred after the first week (p<0.001).
  
  
  CONCLUSIONS
  Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT.
authors.affiliation: Cardiovascular Intensive Cardiac Unit, San Camillo Hospital, Rome-Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pugliese
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Vitali
authors.forename: Enrico
authors.initials: E
authors.lastname: Natale
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: De Girolamo
authors.forename: Giordano
authors.initials: G
authors.lastname: Zampi
authors.forename: Massimo
authors.initials: M
authors.lastname: Leggio
authors.forename: Annalisa
authors.initials: A
authors.lastname: Chiarelli
authors.forename: Augusto
authors.initials: A
authors.lastname: Pappalardo
authors.forename: Andrea
authors.initials: A
authors.lastname: Avella
authors.forename: Francesco
authors.initials: F
authors.lastname: Laurenzi
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Fera
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D058406:Cardiac Resynchronization Therapy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome