Are Left Ventricular Diastolic Function and Diastolic Asynchrony Important Determinants of Response to Cardiac Resynchronization Therapy?

Cardiac resynchronization therapy (CRT) has been shown to reduce symptoms and reverse left ventricular (LV) remodeling. It is not known, however, whether diastolic function will improve after CRT and diastolic asynchrony will predict LV reverse remodeling. Seventy-six patients (mean age 65 ± 12 year...

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Published in:The American journal of cardiology 2006-10, Vol.98 (8), p.1083-1087
Main Authors: Yu, Cheuk-Man, Zhang, Qing, Yip, Gabriel Wai-Kwok, Chan, Yat-Sun, Lee, Pui-Wai, Wu, Li-Wen, Lam, Yat-Yin, Kum, Leo Chi-Chiu, Chan, Hamish Chi-Kin, Chan, Skiva, Fung, Jeffrey Wing-Hong
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Blood pressure
Blood Pressure - physiology
Cardiac Pacing, Artificial
Cardiology
Cardiology. Vascular system
Chi-Square Distribution
Echocardiography
Female
Follow-Up Studies
Heart
Heart Conduction System - physiopathology
Heart Failure - physiopathology
Heart Failure - therapy
Humans
Male
Medical sciences
Medical treatment
Risk Factors
Treatment Outcome
Ultrasonic imaging
Ventricular Function, Left - physiology
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Summary:Cardiac resynchronization therapy (CRT) has been shown to reduce symptoms and reverse left ventricular (LV) remodeling. It is not known, however, whether diastolic function will improve after CRT and diastolic asynchrony will predict LV reverse remodeling. Seventy-six patients (mean age 65 ± 12 years, 74% men) who received CRT were studied at baseline and after 3 months. Diastolic function was assessed by transmitral Doppler and tissue Doppler imaging. LV systolic and diastolic asynchrony were assessed by the time to peak myocardial contraction (Ts) and early diastolic relaxation (Te) using the 6 basal, 6 mid-segmental model. There were 42 responders (55%) with LV reverse remodeling (defined as a reduction of LV end-systolic volume ≥15%). Parameters of systolic function were significantly improved only in the responders. For diastolic function, there were reductions of transmitral E velocity in the 2 groups, without any change in atrial velocity or the E/A ratio. Tissue Doppler imaging revealed that myocardial early diastolic velocity was unchanged in responders but was significantly worsened in nonresponders. The systolic asynchrony index (the SD of Ts of 12 LV segments) correlated significantly with LV reverse remodeling (r = −0.64, p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2006.05.028