Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure

Alonso, Christine; Leclercq, Christophe; Victor, Frédéric; Mansour, Hassan; Place, C. De; Pavin, Dominique; Carré, François; Mabo, Philippe; Daubert, Jean‐Claude

doi:10.1016/s0002-9149(99)00588-3

Cited by 250 publications

(161 citation statements)

References 18 publications

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“…PP and dP/dt max provide direct evidence of the magnitude by which resynchronization assists systolic function in a given patient; therefore, as with a pharmacological agent, one would expect at least a binary discrimination between having some response and long-term benefit. Alonso et al 26 recently reported that QRS narrowing with pacing was more often observed in patients displaying long-term benefit, yet the present data found no immediate relation between such narrowing and mechanical response. This intriguing disparity remains to be resolved by more data and prospective analyses.…”

Section: Discussioncontrasting

confidence: 82%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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Background-VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony. Methods and Results-Twenty-two DCM patients with conduction delay were studied by cardiac catheterization with a dual-sensor micromanometer to measure LV and aortic pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced isovolumetric (dP/dt max ) and ejection-phase (pulse pressure, PP) systolic function by 35Ϯ21% and 16.4Ϯ11%, respectively, and these changes correlated directly (rϭ0.7, Pϭ0.001). %⌬dP/dt max was weakly predicted by baseline QRS (rϭ0.6, PϽ0.02), more strongly by baseline dP/dt max (rϭ0.7, Pϭ0.001), and best by bidiscriminate analysis combining baseline dP/dt max Յ700 mm Hg/s and QRS Ն155 ms to predict %⌬dP/dt max Ն25% and %⌬PP Ն10% (PϽ0.0005, 2 ), with no false-positives. Benefit could not be predicted by %⌬QRS. To test whether basal mechanical dyssynchrony predicted responsiveness to LV pacing, circumferential strains were determined at Ϸ80 sites throughout the LV by tagged MRI in 8 DCM patients and 7 additional control subjects. Strain variance at time of maximal shortening indexed dyssynchrony, averaging 28.0Ϯ7.1% in normal subjects versus 201.4Ϯ84.3% in DCM patients (Pϭ0.001). Mechanical dyssynchrony also correlated directly with %⌬dP/dt max (rϭ0.85, Pϭ0.008). Conclusions-These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dt max provides an excellent tool to identify maximal responders.

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Section: Discussioncontrasting

confidence: 82%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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“…Alonso et al reported that clinical responders had a reduced QRS duration after biventricular pacing. 22 Circulation Journal Vol.70, January 2006 QRS duration was also slightly associated with the change in the severity of MR in our study. Patients with narrow QRS duration were more likely to show an improvement in the severity of MR during follow up.…”

Section: Echocardiographic Follow-up Datasupporting

confidence: 59%

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Amiya

Tanabe

Ikari

et al. 2006

Circ J

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eart failure may be defined as the inability of the heart to meet the demands of the tissues, resulting in symptoms of fatigue or dyspnea on exertion progressing to dyspnea at rest. Patients with nonischemic dilated cardiomyopathy (NIDCM) constitute the largest group of myopathic disorders that are responsible for systolic heart failure. In most multicenter, randomized heart-failure trials, approximately one-third of the enrolled patients have NIDCM. The term NIDCM refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (such as hypertension or valvular disease) or ischemic heart disease.Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and -blockers are the mainstay of treatment in patients with heart failure, irrespective of the etiology and severity of heart failure. ACEI/ARBs and -blockers have been shown to reverse left ventricular (LV) remodeling and improve dyspnea and exercise tolerance, reduce hospitalization rates, and reduce cardiovascular mortality.The prognosis of dilated cardiomyopathy (DCM) has been poor in the past, 1,2 but has improved since ACEI/ARBs Circulation Journal Vol.70, January 2006and -blockers have been widely used as treatment. Azuma et al reported that in Japan the calculated survival rate at 5 years was 90.0% in patients diagnosed with DCM after 1990 in contrast to 62.3% in patients diagnosed before 1989. 3 However, there are still some cases that remain difficult to treat despite the use of ACEI/ARBs and -blockers, and for these biventricular pacing or surgical interventions, such as heart transplantation or the Batista procedure, has been performed. Therefore, risk prediction in patients with NIDCM is crucial for selection of the best treatment strategy, but there were few reports restricted to cases of NIDCM for examining the predictive factors of heart failure.The purpose of this study was to evaluate various factors that might predict an adverse outcome in patients with NIDCM who were treated with ACEI/ARBs and/orblockers. Methods Patient SelectionWe identified 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was diagnosed by echocardiography, coronary angiography, and endomyocardial biopsy, according to the criteria proposed by the WHO/ISFC task force. NIDCM was defined as LV ejection fraction (LVEF) <0.40, a LV end-diastolic diameter (LVEDD) >55 mm on echocardiography, and the absence of significant coronary artery stenosis on angiography. Exclusion Background The goal of the present study was to identify predictors of event-free survival in nonischemic dilated cardiomyopathy (NIDCM) patients after administration of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and -blockers. Methods and ResultsThe study group comprised 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was defined as ejection fraction (EF) <0.40 and left ventricular end-dias...

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“…To date, most clinical studies have used this method, using simultaneous stimuli and highlighting QRS narrowing. 12 LV-only pacing, however, produces similar mechanical and energetic effects as BiV pacing. [1][2][3]5,13 The present study indicates that LV-pacing actually increases electrical dispersion over that from LBBB or BiV pacing, despite improving mechanical function and coordination.…”

Section: Leclercq Et Al Biv Vs LV Pacing and Electromechanical Synchrmentioning

confidence: 95%

Systolic Improvement and Mechanical Resynchronization Does Not Require Electrical Synchrony in the Dilated Failing Heart With Left Bundle-Branch Block

et al. 2002

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Background-Biventricular (BiV) and left ventricular (LV) pacing similarly augment systolic function in left bundlebranch block (LBBB)-failing hearts despite different electrical activation. We tested whether electrical synchrony is required to achieve mechanical synchronization and functional benefit from pacing. Methods and Results-Epicardial mapping, tagged MRI, and hemodynamics were obtained in dogs with LBBB-failing hearts during right atrial, LV, and BiV stimulation. BiV and LV both significantly improved chamber hemodynamics (eg, 25% increase in dP/dt max and aortic pulse pressure) compared with atrial pacing-LBBB, and this improvement correlated with mechanical resynchronization. Electrical dispersion, however, decreased 13% with BiV but increased 23% with LV pacing (PϽ0.01). Conclusion-Improved mechanical synchrony and function do not require electrical synchrony. Mechanical coordination plays the dominant role in global systolic improvement with either pacing approach.

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Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure

Cited by 250 publications

References 18 publications

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Systolic Improvement and Mechanical Resynchronization Does Not Require Electrical Synchrony in the Dilated Failing Heart With Left Bundle-Branch Block

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