Reference : Impact of contractile reserve on acute response to cardiac resynchronization therapy
Scientific journals : Article
Human health sciences : Cardiovascular & respiratory systems
http://hdl.handle.net/2268/11944
Impact of contractile reserve on acute response to cardiac resynchronization therapy
English
Moonen, Marie mailto [Université de Liège - ULg > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation >]
Senechal, Mario mailto [ > > ]
Cosyns, Bernard mailto [ > > ]
Melon, Pierre [Centre Hospitalier Universitaire de Liège - CHU > > Cardiologie >]
Nellessen, Eric mailto [Centre Hospitalier Universitaire de Liège - CHU > > Cardiologie >]
Pierard, Luc mailto [Université de Liège - ULg > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation >]
Lancellotti, Patrizio mailto [Centre Hospitalier Universitaire de Liège - CHU > > Cardiologie >]
31-Dec-2008
Cardiovascular Ultrasound
BioMed Central
6
65
Yes (verified by ORBi)
International
1476-7120
[en] Contractile reserve ; Heart failure ; Cardiac resynchronization therapy ; LV dyssynchrony ; Exercise echocardiography
[en] Background: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation.
Methods: Fifty-one consecutive patients with heart failure (LV ejection fraction 27% ± 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume ≥15% after CRT.
Results: Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p<0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p<0.0001).
Conclusions: Heart failure patients referred to CRT have less chance of improving under therapy if they have no significant mitral regurgitation, no LV dyssynchrony and no contractile myocardial recruitment at exercise.
Service de Cardiologie, Prof. Luc Piérard, CHU SART TILMAN.
Fonds de la Recherche Scientifique (Communauté française de Belgique) - F.R.S.-FNRS
Researchers ; Professionals
http://hdl.handle.net/2268/11944
10.1186/1476-7120-6-65
http://www.cardiovascularultrasound.com/content/6/1/65

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