Importance of contractile reserve for CRT

Lim, Pascal; Bars, Clément; Mitchell-Heggs, Laurens; Roiron, Cécile; Elbaz, Nathalie; Hamdaoui, Brahim; Lellouche, Nicolas; Dubois‐Randé, Jean‐Luc; Guéret, Pascal

doi:10.1093/europace/eum117

Cited by 30 publications

(33 citation statements)

References 40 publications

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“…after CRT implantation Myocardial viability and contractile reserve belong to the determinants of CRT effectiveness in both ischaemic and non-ischaemic cardiomyopathy [11][12][13][14]. Lim et al [11] used LDSE to assess contractile reserve, and demonstrated that contractile reserve preserved in the paced LV region correlates with an acute haemodynamic response and the LV reverse remodelling six months after CRT.…”

Section: Inotropic Contractile Reserve and Fmrimentioning

confidence: 99%

“…Lim et al [11] used LDSE to assess contractile reserve, and demonstrated that contractile reserve preserved in the paced LV region correlates with an acute haemodynamic response and the LV reverse remodelling six months after CRT. However, these authors did not analyse the relationship between contractile reserve and FMRI in response to CRT.…”

Section: Inotropic Contractile Reserve and Fmrimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…This latter effect is generally believed to develop at mid-and long-term follow-up, i.e. months after CRT implantation [2,6,7,9].It is noteworthy that the outcome of CRT is related to myocardial contractile reserve and viability in the paced left ventricular region [11]. Myocardial viability can be examined with several validated techniques, applied in ischaemic and non-ischaemic cardiomyopathy.…”

mentioning

confidence: 99%

“…Myocardial viability can be examined with several validated techniques, applied in ischaemic and non-ischaemic cardiomyopathy. Contractile reserve assessed by means of a widely available low-dose dobutamine stress-echo (LDSE) has high sensitivity and specificity [11][12][13][14].Little is known about the predictors of FMRI after CRT implantation in short-term observation. While the role of preserved contractile reserve as a predictor of post-CRT clinical improvement and the LV reverse remodelling is well documented, its predictive value with regards to FMRI is unclear.…”

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confidence: 99%

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Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

Brzezińska¹,

Łoboz‐Grudzień

Wita

et al. 2016

Kardiol Pol

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A b s t r a c t Background and aim:The study was undertaken to assess the predictive role of myocardial contractile reserve for functional mitral regurgitation (FMR) improvement after cardiac resynchronisation therapy (CRT), and to define other predictors of FMR improvement (FMRI) and the impact of FMRI on left ventricular (LV) reverse remodelling. Methods and results:Among 90 patients in whom echocardiography was performed one day before and six weeks after CRT implantation, 66 with at least FMR(2+) in a four-point scale (mean age 64 ± 10 years, mean LV ejection fraction [LVEF] 25.7 ± 6%, ischaemic aetiology 48%) were included. FMRI was defined as the reduction of the FMR severity by at least one grade. The patients were divided into groups: A with FMRI (n = 30) and B without FMRI (n = 36). Contractile reserve was evaluated using low-dose dobutamine stress-echo before CRT implantation and was defined as a relative improvement in LVEF of more than 20% and segmental contractility improvement. Reverse remodelling was defined as the reduction of the LV end-systolic volume (LVESV) by at least 15%. Cox regression multivariate analysis revealed the following predictors for FMRI: contractile reserve preserved in more than three segments with an OR = 5.7 (95% CI 1.81-17.97, p = 0.005, sensitivity 65.5%, specificity 72.2%, AUC = 0.727) and LV end-diastolic diameter ≤ 74 mm with an OR = 2.09 (95% CI 0.75-5.78, p < 0.05, sensitivity 80.0%, specificity 47.2%, AUC = 0.632). FMRI was associated with greater reduction of LVESV (p = 0.002), greater increase in LVEF (p < 0.001) and higher incidence of the LV reverse remodelling (p < 0.001). Conclusions:Preserved contractile reserve and lesser degree of LV dilation were predictive factors of short-term FMR improvement after CRT implantation. FMR improvement was associated with higher incidence of the LV reverse remodelling early, already in the six weeks after CRT implantation. 666INTRODUCTION Cardiac resynchronisation therapy (CRT) is an established treatment option for patients with advanced chronic heart failure and prolonged QRS duration. The outcome of CRT is determined by a number of factors, and the improvement of functional mitral regurgitation (FMR) is one of the mechanisms behind the beneficial effect of the treatment [1, 2].Significant FMR has important prognostic implications and is associated with a relatively high morbidity and mortality [3]. FMR caused by dilation, altered geometry, and systolic dysfunction of the left ventricle (LV) can itself promote progressive remodelling in the course of ischaemic or non-ischaemic dilated cardiomyopathy [4,5]. This results in a vicious circle, with both LV dilatation and FMR acting as self-perpetuating processes. CRT may contribute to the reduction of FMR and reversing LV dilation [6,7].Functional mitral regurgitation, observed in patients with ischaemic and non-ischaemic cardiomyopathy, results from an imbalance between LV closing forces and mitral valve tethering forces, and resultant deformation of mitral valve geometry ...

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