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See detailUsefulness and limitation of dobutamine stress echocardiography to predict acute response to cardiac resynchronization therapy.
Sénéchal, Marie; Lancellotti, Patrizio ULg; Garceau, P. et al

in Echocardiography (2010), 27(1), 50-57

Background: It has been hypothesized that a long-term response to cardiac resynchronization therapy (CRT) could correlate with myocardial viability in patients with left ventricular (LV) dysfunction ... [more ▼]

Background: It has been hypothesized that a long-term response to cardiac resynchronization therapy (CRT) could correlate with myocardial viability in patients with left ventricular (LV) dysfunction. Contractile reserve and viability in the region of the pacing lead have not been investigated in regard to acute response after CRT. Methods: Fifty-one consecutive patients with advanced heart failure, LV ejection fraction ≤ 35%, QRS duration > 120 ms, and intraventricular asynchronism ≥ 50 ms were prospectively included. The week before CRT implantation, the presence of viability was evaluated using dobutamine stress echocardiography. Acute responders were defined as a ≥15% increase in LV stroke volume. Results: The average of viable segments was 5.8 ± 1.9 in responders and 3.9 ± 3 in nonresponders (P = 0.03). Viability in the region of the pacing lead had an excellent sensitivity (96%), but a low specificity (56%) to predict acute response to CRT. Mitral regurgitation (MR) was reduced in 21 patients (84%) with acute response. The presence of MR was a poor predictor of response (sensibility 93% and specificity 17%). However, combining the presence of MR and viability in the region of the pacing lead yields a sensibility (89%) and a specificity (70%) to predict acute response to CRT. Conclusion: Myocardial viability is an important factor influencing acute hemodynamic response to CRT. In acute responders, significant MR reduction is frequent. The combined presence of MR and viability in the region of the pacing lead predicts acute response to CRT with the best accuracy. [less ▲]

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See detailContractile reserve assessed using dobutamine echocardiography predicts left ventricular reverse remodeling after cardiac resynchronization therapy: prospective validation in patients with left ventricular dyssynchrony.
Sénéchal, Mario; Lancellotti, Patrizio ULg; Magne, Julien ULg et al

in Echocardiography (2010), 27(6), 668-76

Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony ... [more ▼]

Background: The presence of viable myocardium may predict response to cardiac resynchronization therapy (CRT). The aim of this study is to evaluate in patients with left ventricular (LV) dyssynchrony whether response to CRT is related to myocardial viability in the region of the pacing lead. Methods: Forty-nine consecutive patients with advanced heart failure, LV ejection fraction < 35%, QRS duration > 120 ms and intraventricular asynchronism ≥ 50 ms were included. Dobutamine stress echocardiography was performed within the week before CRT implantation. Resting echocardiography was performed 6 months after CRT implantation. Viability in the region of LV pacing lead was defined as the presence of viability in two contiguous segments. Response to CRT was defined by evidence of reverse LV remodeling (≥15% reduction in LV end-systolic volume). Results: Thirty-one patients (63%) were identified as responders at follow-up. The average of viable segments was 5.9 ± 2 in responders and 3.2 ± 3 in nonresponders (P = 0.0003). Viability in the region of the pacing lead had a sensitivity of 94%, a specificity of 67%, a positive predictive value of 83%, and a negative predictive value of 86% for the prediction of response to CRT. Conclusions: In patients with LV dyssynchrony, reverse remodeling after CRT requires viability in the region of the pacing lead. This simple method using echocardiography dobutamine for the evaluation of local viability (i.e., viability in two contiguous segments) may be useful to the clinician in choosing the best LV lead positioning. [less ▲]

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See detailUsefulness of cardiac resynchronisation therapy in patients with right bundle branch block: is viability an important piece of the puzzle?
O'Connor, K.; Sénéchal, M.; Lancellotti, Patrizio ULg et al

in International Journal of Cardiology (2010), 145(1), 17-20

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See detailUsefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy
Magne, Julien ULg; Dubois, M.; Champagne, J. et al

in Cardiovascular Ultrasound (2009), 7(1),

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