European Heart Journal Advance Access originally published online on April 13, 2006
European Heart Journal 2006 27(12):1423-1430; doi:10.1093/eurheartj/ehi885
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Differential change in left ventricular mass and regional wall thickness after cardiac resynchronization therapy for heart failure
1 Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, S.H. Ho Cardiovascular and Stroke Centre, Institute of Vascular Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
2 Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
Received 16 December 2005; revised 14 March 2006; accepted 23 March 2006; online publish-ahead-of-print 13 April 2006.
* Corresponding author. Tel: +852 2632 3594; fax: +852 2637 5643. E-mail address: cmyu{at}cuhk.edu.hk
See page 1392 for the editorial comment on this article (doi:10.1093/eurheartj/ehl048)
Aims LV reverse remodelling has been shown to be a favourable response after cardiac resynchronization therapy (CRT) in many clinical trials. This study investigated whether left ventricular (LV) reverse remodelling after CRT has any structural benefit, which include the improvement of LV mass or regional wall thickness.
Methods and results Fifty patients (66±11 years) receiving CRT were followed up for at least 3 months. Echocardiography with tissue Doppler imaging was performed serially before and at day 1 and 3 months after CRT. Although LV end-systolic volume (LVESV) was decreased at day 1 after CRT (141±74 vs. 129±71 cm3, P<0.001), further LV reverse remodelling was observed at 3 months (110±67 cm3, P<0.001 vs. day 1). LV ejection fraction increased at day 1 (26.5±9.3 vs. 28.5±9.1%, P<0.005) and was further improved at 3 months (34.2±10.5%, P<0.001 vs. day 1). However, reduction of LV mass (231±67 vs. 213±59 g, P<0.001) and regional wall thickness was only observed at 3 months, but not at day 1. The improvement of LV mass correlated with the change in LVESV (r=0.66, P<0.001) and the baseline systolic asynchrony index (Ts-SD) (r=–0.52, P<0.001). LV mass was only decreased significantly in responders of LV reverse remodelling (245±66 vs. 207±61 g, P<0.001), but increased in non-responders (209±64 vs. 223±56 g, P=0.02). Responders had significant decrease in thickness of all the four walls for –6 to –11% (all P
0.02), whereas non-responders had increased thickness in septal and lateral walls for +11% (both P<0.05).
Conclusion The acute reduction in LV volume after CRT is mediated by haemodynamic and geometric benefits without actual changes in LV mass. However, at 3-month follow-up, reduction in LV mass and regional wall thickness was demonstrated, which represents structural reverse remodelling. Such benefit was only observed in volumetric responders but was worsened in non-responders.
Key Words: Cardiac resynchronization therapy • Left ventricular mass • Reverse remodelling • Echocardiography
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