Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy.

Abstract

OBJECTIVES:

We sought to evaluate the long-term impact of cardiac resynchronization therapy (CRT) on left ventricular (LV) performance and remodeling using three-dimensional echocardiography and tissue Doppler imaging (TDI).

BACKGROUND:

Three-dimensional echocardiography and TDI allow rapid and accurate evaluation of LV volumes and performance.

METHODS:

Twenty-five consecutive patients with severe heart failure and bundle branch block who underwent biventricular pacemaker implantation were included. Before and after implantation of the pacemaker, three-dimensional echocardiography and TDI were performed. These examinations were repeated at outpatient visits every six months.

RESULTS:

Five patients (20%) died during one-year follow-up. In the remaining 20 patients, significant reductions in LV end-diastolic volume and LV end-systolic volume of 9.6 +/- 14% and 16.5 +/- 15%, respectively (p < 0.01), could be demonstrated during long-term follow-up. Accordingly, LV ejection fraction increased by 21.7 +/- 18% (p < 0.01). According to a newly developed TDI technique-tissue tracking-all regional myocardial segments improved their longitudinal systolic shortening (p < 0.01). The extent of the LV base displaying delayed longitudinal contraction, as detected by TDI before pacemaker implantation, predicted long-term efficacy of CRT. The QRS duration failed to predict resynchronization efficacy.

CONCLUSIONS:

Cardiac resynchronization significantly improved LV function and reversed LV remodeling during long-term follow-up. Patients likely to benefit from CRT can be identified by TDI before implantation of a biventricular pacemaker.

• Authors: Peter Søgaard, Henrik Egeblad, W Yong Kim, Henrik K Jensen, Anders K Pedersen, Bent Ø Kristensen, Peter T Mortensen
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 40 Issue 4 Pg. 723-30 (Aug 21 2002) ISSN: 0735-1097 [Print] United States
• PMID: 12204503 (Publication Type: Evaluation Study, Journal Article)

Topics

• Bundle-Branch Block (diagnostic imaging, physiopathology, therapy)
• Cardiac Pacing, Artificial (methods)
• Echocardiography, Doppler, Color
• Echocardiography, Three-Dimensional
• Heart Failure (diagnostic imaging, physiopathology, therapy)
• Humans
• Prognosis
• Systole (physiology)
• Ventricular Remodeling