Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy

Lancellotti, Patrizio; Sénéchal, Mario; Moonen, Marie; Donal, Erwan; Magné, Julien; Nellessen, Eric; Attena, Emilio; Cosyns, Bernard; Mélon, Pierre; Piérard, Luc

doi:10.1093/ejechocard/jep033

Cited by 40 publications

(23 citation statements)

References 24 publications

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“…27 Similarly, absence of contractile reserve in the region of the LV pacing as manifested by no significant changes in wall motion score during stress echocardiography precludes LV reverser remodeling in most patients. 29,30 In line with these data, we found that responders to CRT showed greater wall motion improvement in the region of the LV pacing lead during stress compared to nonresponders. Furthermore, these data indicate that a substantial amount of recruitable myocardium is needed to obtain improvement in LV function after CRT.…”

Section: Discussionsupporting

confidence: 81%

Impact of Mitral Regurgitation and Myocardial Viability on Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy

Sénéchal¹,

Lancellotti²,

Magné³

et al. 2010

The American Journal of Cardiology

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This study investigated the impact of ischemic mitral regurgitation (MR) severity and viability on left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy. Severe MR and ischemic cardiomyopathy have been associated with lack of LV reverse remodeling after CRT. Fifty-seven consecutive patients with ischemic MR, LV ejection fraction <35%, QRS duration >120 ms, and intraventricular dyssynchrony >50 ms were prospectively included. Stress echocardiography was performed before CRT implantation. Viability in the region of the LV pacing lead was defined as the presence of viability in 2 contiguous segments. Response to CRT at 6 months was defined by evidence of >15% LV decrease in end-systolic volume. Severe MR was defined by an effective regurgitant orifice (ERO) area >20 mm 2 . Thirtythree patients (58%) were responders at follow-up. Baseline ERO area and prevalence of severe MR were not different between responders and nonresponders (19 ؎ 11 vs 21 ؎ 13 mm 2 , p ‫؍‬ 0.67; 52% vs 53%, p ‫؍‬ 0.84). In responders, MR was decreased by 58% (ERO 19 ؎ 12 to 8 ؎ 6 mm 2 ). In the presence of viability in the region of the pacing lead, 74% (n ‫؍‬ 29 patients) were responders (sensitivity 88%, specificity 58%); in the subgroup of patients with viability in the region of the pacing lead and severe MR, 83% (n ‫؍‬ 17 patients) were responders. In conclusion, LV remodeling is frequent and ischemic MR decrease important in patients with viability in the region of the pacing lead without regard to MR severity. © 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:31-37) Ischemic heart disease is the most common cause of systolic left ventricular (LV) dysfunction. The prognosis of these patients is particularly modulated by the extent of residual viable myocardium. Cardiac resynchronization therapy (CRT) improves LV function and geometry, exercise capacity, and outcomes of appropriately selected patients with heart failure.1-3 CRT leads to a decrease in mitral regurgitation (MR) severity at rest and during exercise by an increase of LV function and local synchronicity (decrease in mechanical activation delay of papillary muscles). 4 -11 Response to CRT largely depends on extent of LV dyssynchrony, severity of LV remodeling, extent of scar tissue, and possibility offered to the left ventricle to recruit function (contractile reserve). Whether the presence of MR and its severity could modulate the response to CRT is still controversial. Several investigators have suggested that extent of LV reverse remodeling could be lessened in patients with significant MR, particularly in the setting of ischemic cardiomyopathy. [12][13][14] This study investigated the potential impact of MR severity and myocardial contractile reserve on acute and long-term responses to CRT in patients with ischemic cardiomyopathy and significant LV dyssynchrony. MethodsFrom May 2005 to March 2008, 57 patients (mean age 71 Ϯ 8 years, 43 men, (75%) were prospectively enrolled in the Inst...

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Section: Discussionsupporting

confidence: 81%

Impact of Mitral Regurgitation and Myocardial Viability on Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy

Sénéchal¹,

Lancellotti²,

Magné³

et al. 2010

The American Journal of Cardiology

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“…Improvement in LVEF at peak exercise before multisite pacing correlated with improvement in forward LV stroke volume early after CRT 39. More recently, we have demonstrated that a 6.5% exercise-induced increase in LVEF yielded a sensitivity of 90% and a specificity of 85% to predict late response to CRT 40. Rocchi et al also applied exercise echocardiography in this indication and determined that regional CR in the pacing site of the LV lead was associated with response to CRT at a 6 month follow-up 19…”

Section: Assessment Of Contractile Reservementioning

confidence: 71%

Stress echocardiography for selecting potential responders to cardiac resynchronisation therapy

Moonen¹,

O’Connor

Magné

et al. 2010

Heart

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“…In this study, we found that in the setting of ischemic dilated cardiomyopathy an important difference in the response to CRT may exist in relation to the presence of MV. The patients with a consistent amount of MV could respond better to CRT implantation (41)(42)(43).…”

Section: Discussionmentioning

confidence: 96%

Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study

Pugliese¹,

Minardi²,

Vitali³

et al. 2012

Anadolu Kardiyol Derg

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Objective: To understand whether patients with post-ischemic dilated cardiomyopathy and myocardial viability (MV) could benefit from cardiac resynchronization therapy (CRT) in terms of clinical, echocardiographic and neuro-hormonal parameters compared to patients without MV. Methods: One hundred and four consecutive patients were enrolled in a prospective observational cohort study. Using dobutamine stress echocardiography, 2 groups were identified: group A of 51 patients with MV and group B of 53 patients without MV. All patients were implanted with biventricular pacing devices combined with an internal cardioverter-defibrillator. Clinical, echocardiographic and neuro-hormonal parameters were evaluated at baseline and at six month follow-up. Analysis of variance for repeated measures on each variable suggestive of remodeling was performed. We considered responder every patient with: decrease of > 15% in left ventricular volumes and/or improvement in left ventricular ejection fraction of > 5% in addition to NYHA class improvement. Results: All the variables improved in both groups (time effect). Comparing the two groups (group effect), the following variables were significantly better in group A: N-terminal pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection fraction (p=0.009), 3 rd sound (p=0.01), and left ventricular end-systolic volume after the first week (p=0.035). RR occurred at the first week after CRT only in Group A and was maintained for all the time of this study. The maximum difference of the decrease of left ventricular volumes between the two groups occurred after the first week (p<0.001). Conclusion: Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT. (Anadolu Kardiyol Derg 2012; 12: 132-41)

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Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy

Abstract: Myocardial contractile reserve (global and regional) is a strong predictive factor of LV reverse remodelling after CRT.

Cited by 40 publications

References 24 publications

Impact of Mitral Regurgitation and Myocardial Viability on Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy

Impact of Mitral Regurgitation and Myocardial Viability on Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy

Stress echocardiography for selecting potential responders to cardiac resynchronisation therapy

Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study

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