Author + information
- Stian Ross,
- Hans Henrik Odland,
- Thor Edvardsen,
- Richard Cornelussen,
- Lars Ove Gammelsrud and
- Erik Kongsgaard
Background: Presence of myocardial contractile reserve in a failing heart has been proposed as a key factor to CRT response and is a prerequisite to utilize increased preload and thus improve left ventricular (LV) performance. The purpose of this study was to explore to what extent a utilization of increased preload due to a shortened AV interval would predict acute CRT response.
Methods: Twenty-nine heart failure patients with left bundle branch block (LBBB) underwent CRT implant with continuous LV pressure registration. Atrial pacing at a rate 10 % above intrinsic rhythm served as baseline. Dual right ventricular pacing (AP-RVP) and biventricular pacing (AP-BIVP) were performed at the same cycle length and with identical AV delay. LV performance was assessed as the % change in LV dP/dtmax. Patients with an LV dP/dtmax increase ≥10% with AP-BIVP were classified as acute CRT responders.
Results: Ability to utilize the shortened AV delay with AP-RVP was only seen in patients with acute CRT response (table). ROC curve analysis of % change in LV dP/dtmax with AP-RVP identified 0.2% as the optimal cut-off value (sensitivity 0.90, specificity 0.70) for prediction of acute CRT response, AUC=0.81 [95% CI: 0.63-0.99]. In all patients a significant correlation was seen between % change in LV dP/dtmax with AP-RVP and % change in LV dP/dtmax with AP-BIVP (R = 0.57, p < 0.01).
Conclusions: Increased LV dP/dtmax with AP-RVP verifies a myocardial contractile reserve in heart failure patients with LBBB and predicts acute CRT response.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Heart Failure Gadgets Galore
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1199-250
- 2017 American College of Cardiology Foundation