Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography

Ghio, Stefano; Alessandrino, Giuseppe; Albertini, Riccardo; Klersy, Catherine; Girardi, Bruna; Maggi, G; Pazzano, Anna Sara; Raineri, Claudia; Visconti, Luigi Oltrona

doi:10.2459/jcm.0000000000000034

Cited by 1 publication

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“…Even during systolic heart failure, increased LV filling pressure is closely associated with exercise limitation and is independent of the degree of systolic dysfunction 8. Studies have increasingly indicated that severe diastolic dysfunction (restrictive filling) suggests a worse hemodynamic and clinical status of heart failure as well as increased mortality and heart transplantation rates 22, which is also true for patients undergoing drug treatment 23,24, surgical ventricular restoration 25,26, and CRT 27,28. Using multivariate regression analysis, this study confirmed that severe diastolic dysfunction was an independent factor that influenced the CRT response.…”

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confidence: 99%

Abnormal diastolic function underlies the different beneficial effects of cardiac resynchronization therapy on ischemic and non-ischemic cardiomyopathy

Wang

Chen

et al. 2017

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OBJECTIVES:To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes.METHODS:The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters.RESULTS:The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy.CONCLUSIONS:This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.

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