PUMA
Istituto di Fisiologia Clinica     
Ciampi Q., Pratali L., Citro R., Piacenti M., Villari B., Picano E. Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography. In: European Journal of Heart Failure, vol. 11 pp. 489 - 496. Oxford Journals, 2009.
 
 
Abstract
(English)
Aims The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. Methods and results Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction 35%, New York Heart Association III, and QRS duration 120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 mg/kg/min: CR was defined as a wall motion score index (WMSI) variation 0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease 15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P 0.001) and in 69% with reverse remodelling (P 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r 0.439, P 0.003) and in WMSI (r 0.450, P 0.001), but not with DYS. CR (OR 6.2, 95% CI 1.4-27.6, P 0.015) was the best predictor of response to CRT. Conclusion Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response.
DOI: 10.1093/eurjhf/hfp039
Subject Echocardiography


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