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European Heart Journal Advance Access originally published online on November 5, 2008
European Heart Journal 2009 30(1):89-97; doi:10.1093/eurheartj/ehn483
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy

Guido Rocchi*, Matteo Bertini, Mauro Biffi, Matteo Ziacchi, Elena Biagini, Ilaria Gallelli, Cristian Martignani, Elena Cervi, Marinella Ferlito, Claudio Rapezzi, Angelo Branzi and Giuseppe Boriani

Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy

Received 1 May 2008; revised 24 September 2008; accepted 9 October 2008; online publish-ahead-of-print 5 November 2008.

* Corresponding author. Tel: +39 (0) 51 349858, Fax: +39 (0) 51 344859, Email: guidorocchi{at}libero.it

Aims: Cardiac resynchronization therapy (CRT) improves functional capacity and survival in heart failure. However, one-third of patients fail to respond to CRT. Resting left ventricular (LV) dyssynchrony assessed by echocardiography (ECHO) showed discordant results in identifying CRT responders. LV dyssynchrony can totally change during exercise. Aim of this study was to evaluate whether exercise dyssynchrony could select responders to CRT.

Methods and results: Sixty-four patients scheduled for CRT implantation performed bicycle exercise ECHO in semi-supine position on an exercise tilting table before and 6 months after CRT implantation. Tissue Doppler imaging (TDI) was acquired both at rest and during exercise to detect LV mechanical dyssynchrony. Predictive values for CRT response were 70% for rest TDI and 89% for exercise TDI (P = 0.01). Exercise LV dyssynchrony was the only parameter independently associated with follow-up improvement of rest ejection fraction and LV volume during multivariable analysis (P < 0.001). Functional improvement at 6-min walking test was statistically higher in patients with exercise dyssynchrony (P = 0.005), and not different considering rest dyssynchrony (P = 0.30).

Conclusion: Exercise intraventricular dyssynchrony assessed by exercise TDI ECHO is a strong independent predictor of CRT response. It could be used to select candidates for CRT, thus reducing ineffective implantations of biventricular pacemakers.

Key Words: Exercise echocardiography • Tissue Doppler imaging • Cardiac resynchronization therapy • Heart failure


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