Author + information
- Received November 27, 2010
- Revision received March 23, 2011
- Accepted April 12, 2011
- Published online September 6, 2011.
- Simon G. Duckett, MBBS⁎,†,⁎ (, )
- Matthew Ginks, MBBS⁎,†,
- Anoop K. Shetty, MBBS⁎,†,
- Julian Bostock, MSc†,
- Jaswinder S. Gill, MD†,
- Shoaib Hamid, MD†,
- Stam Kapetanakis, MD†,
- Eliane Cunliffe, BSc†,
- Reza Razavi, MD⁎,†,
- Gerry Carr-White, PhD† and
- C. Aldo Rinaldi, MD⁎,†
- ↵⁎Reprint requests and correspondence:
Dr. Simon G. Duckett, Division of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London SE1 7EH, United Kingdom
Objectives We evaluated the relationship between acute hemodynamic response (AHR) and reverse remodeling (RR) in cardiac resynchronization therapy (CRT).
Background CRT reduces mortality and morbidity in heart failure patients; however, up to 30% of patients do not derive symptomatic benefit. Higher proportions do not remodel. Multicenter trials have shown echocardiographic techniques are poor at improving response rates. We hypothesized the degree of AHR at implant can predict which patients remodel.
Methods Thirty-three patients undergoing CRT (21 dilated and 12 ischemic cardiomyopathy) were studied. Left ventricular (LV) volumes were assessed before and after CRT. The AHR (maximum rate of left ventricular pressure [LV-dP/dtmax]) was assessed at implant with a pressure wire in the LV cavity. Largest percentage rise in LV-dP/dtmax from baseline (atrial antibradycardia pacing or right ventricular pacing with atrial fibrillation) to dual-chamber pacing (DDD)-LV was used to determine optimal coronary sinus LV lead position. Reverse remodeling was defined as reduction in LV end systolic volume ≥15% at 6 months.
Results The LV-dP/dtmax increased significantly from baseline (801 ± 194 mm Hg/s to 924 ± 203 mm Hg/s, p < 0.001) with DDD-LV pacing for the optimal LV lead position. The LV end systolic volume decreased from 186 ± 68 ml to 157 ± 68 ml (p < 0.001). Eighteen (56%) patients exhibited RR. There was a significant relationship between percentage rise in LV-dP/dtmax and RR for DDD-LV pacing (p < 0.001). A similar relationship for AHR and RR in dilated cardiomyopathy and ischemic cardiomyopathy (p = 0.01 and p = 0.006) was seen.
Conclusions Acute hemodynamic response to LV pacing is useful for predicting which patients are likely to remodel in response to CRT both for dilated cardiomyopathy and ischemic cardiomyopathy. Using AHR has the potential to guide LV lead positioning and improve response rates.
- acute hemodynamic response
- cardiac resynchronization therapy
- heart failure
- reverse remodeling
This work was supported by the European Community Seventh Framework Programme Grant Agreement n. 224495 (euHeart project). Drs. Ginks, Shetty, and Gill have received research funding from St. Jude Medical. Dr. Razavi has received research funding from Philips Healthcare and St. Jude Medical. Dr. Carr-White has received support from Medtronic and St. Jude Medical. Dr. Rinaldi has received research funding from St. Jude and Medtronic and is a consultant to St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 27, 2010.
- Revision received March 23, 2011.
- Accepted April 12, 2011.
- American College of Cardiology Foundation