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Shanks, M.; Bertini, M.; Delgado, V.; Ng, A.C.T.; Nucifora, G.; Bommel, R.J. van; ... ; Bax, J.J. (2010)

Effect of Biventricular Pacing on Diastolic Dyssynchrony

Article / Letter to editor
Objectives This study sought to examine the changes in diastolic dyssynchrony with cardiac resynchronization therapy (CRT). Background Little is known about the effect of CRT on diastolic dyssynchrony. Methods Consecutive heart failure patients (n = 266, age 65.7 +/- 10.0 years) underwent color-coded tissue Doppler imaging at baseline, 48 h, and 6 months after CRT. Systolic and diastolic dyssynchrony were defined as maximal time delay in peak systolic and early diastolic velocities, respectively, in 4 basal LV segments. CRT responders were defined as those with >= 15% decrease in LV end-systolic volume at 6 months. Results Baseline LVEF was 25.2 +/- 8.1%; 63.5% patients were CRT responders. Baseline incidence of systolic and diastolic dyssynchrony, and a combination of both was 46.2%, 51.9%, and 28.6%, respectively. Compared to nonresponders, responders had longer baseline systolic (79.2 +/- 43.4 ms vs. 45.4 +/- 30.4 ms; p < 0.001) and diastolic (78.5 +/- 52.0 ms vs. 50.1 +/- 38.2...Show moreObjectives This study sought to examine the changes in diastolic dyssynchrony with cardiac resynchronization therapy (CRT). Background Little is known about the effect of CRT on diastolic dyssynchrony. Methods Consecutive heart failure patients (n = 266, age 65.7 +/- 10.0 years) underwent color-coded tissue Doppler imaging at baseline, 48 h, and 6 months after CRT. Systolic and diastolic dyssynchrony were defined as maximal time delay in peak systolic and early diastolic velocities, respectively, in 4 basal LV segments. CRT responders were defined as those with >= 15% decrease in LV end-systolic volume at 6 months. Results Baseline LVEF was 25.2 +/- 8.1%; 63.5% patients were CRT responders. Baseline incidence of systolic and diastolic dyssynchrony, and a combination of both was 46.2%, 51.9%, and 28.6%, respectively. Compared to nonresponders, responders had longer baseline systolic (79.2 +/- 43.4 ms vs. 45.4 +/- 30.4 ms; p < 0.001) and diastolic (78.5 +/- 52.0 ms vs. 50.1 +/- 38.2 ms; p < 0.001) delays. In follow-up, systolic delays (45.4 +/- 31.6 ms at 48 h; 38.9 +/- 26.2 ms at 6 months; p < 0.001) and diastolic delays (49.4 +/- 36.3 ms at 48 h; 37.7 +/- 26.0 ms at 6 months; p < 0.001) improved only in responders. Conclusions At baseline: 1) diastolic dyssynchrony was more common than systolic dyssynchrony in HF patients; 2) nonresponders had less baseline diastolic dyssynchrony compared to responders. After CRT: 1) diastolic dyssynchrony improved only in responders. Further insight into the pathophysiology of diastolic dyssynchrony and its changes with CRT may provide incremental information on patient-specific treatments. (J Am Coll Cardiol 2010;56:1567-75) (C) 2010 by the American College of Cardiology FoundationShow less
cardiac resynchronization therapy diastole dyssynchrony echocardiography heart failure cardiac resynchronization therapy coronary-artery-disease left-ventricular dyssynchrony chronic heart-failure bundle-branch block doppler-echocardiography systolic asynchrony dilated cardiomyopathy recommendations synchronicity
All authors
Shanks, M.; Bertini, M.; Delgado, V.; Ng, A.C.T.; Nucifora, G.; Bommel, R.J. van; Borleffs, C.J.W.; Holman, E.R.; Veire, N.R.L. van de; Schalij, M.J.; Bax, J.J.
Date
2010-11-02
Journal
Journal of the American College of Cardiology
Volume
56
Issue
19
Pages
1567 - 1575
DOI
doi:10.1016/j.jacc.2010.01.077