European Heart Journal Advance Access originally published online on April 21, 2007
European Heart Journal 2007 28(9):1143-1148; doi:10.1093/eurheartj/ehm050
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Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome
Cardiac Arrhythmia Service and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
Received 28 June 2006; revised 19 February 2007; accepted 1 March 2007; online publish-ahead-of-print 21 April 2007.
* Corresponding author. Tel: +1 617 726 4662; fax: +1 617 726 3852. E-mail address: jsingh{at}partners.org
See page 1049 for the editorial comment on this article (doi:10.1093/eurheartj/ehm039)
Aims: Although acute haemodynamic improvement in response to cardiac resynchronization therapy (CRT) is reflective of a favourable cardiac contractile response, there is limited information regarding not only its ability to predict long-term clinical outcome but also cardiac-substrate-specific differences in the prognostic value of this measure.
Methods and results: Fifty-three heart failure patients (69 ± 11 years) with low left ventricle ejection fraction (LVEF) (22 ± 6%), wide QRS (169 ± 31 ms), and indications for CRT were included. There were no significant differences in age, New York Heart Association (NYHA) class, medications, QRS width, or LVEF between ischaemic (n = 37) and non-ischaemic (n = 16) groups. Echocardiograms were performed within 24 h of implantation with device OFF and ON. Acute haemodynamic response was measured as LV dP/dt derived from the CW Doppler of mitral regurgitation. Percentage change in dP/dt was used to classify patients: high- (HR: 
dP/dt > 25%) or poor-responders (PR: dP/dt 
25%). Clinical response to CRT was defined by a combined endpoint of hospitalizations and all-cause mortality at 12 months. HR group had a significantly better outcome compared to the PR group (P-value = 0.004) irrespective of the aetiology of the cardiomyopathy.
Conclusion: Echocardiographic assessment of the acute haemodynamic response to CRT predicts long-term clinical outcome in both ischaemic and non-ischaemic cardiomyopathy.
Key Words: dP/dt • Resynchronization • Doppler • Long-term outcome • Cardiomyopathy • Heart failure
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EHJ 2007 28: 1049-1051.[Extract] [Full Text]
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