European Heart Journal Advance Access published online on August 1, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl179
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1 Department of Echocardiography, Royal Brompton Hospital and Imperial College, Sydney Street, London SW3 6NP, UK
* To whom correspondence should be addressed. Aims Cardiac resynchronization therapy (CRT) reduces inter- and intraventricular dyssynchrony and shortens total isovolumic time (t-IVT). We compared the extent to which the values of ventricular dyssynchrony and t-IVT predict clinical benefits of CRT. Methods and results Ventricular dyssynchrony was assessed in 39 patients with heart failure before and 6 months after CRT. Segmental dyssynchrony was identified from time to onset and peak systolic velocity of wall motion. T-IVT (s/min) was derived as [60 - (total ejection time+total filling time)]. The difference between ventricular pre-ejection periods (D-PEP) was calculated. Outcome measures were fall in New York Heart Association (NYHA) class and increase in cardiac output (CO). Following CRT, NYHA class fell in 29/39 patients, CO increased (by 1.0 L/min, P < 0.001), and intraventricular delay (Intra-VD), interventricular delay (Inter-VD), t-IVT, and D-PEP shortened (by 25 ms, 72 ms, 6 s/min, and 38 ms, P < 0.01). NYHA class and CO were unchanged with CRT in 10/39, and Intra-VD, Inter-VD, t-IVT, and D-PEP lengthened (by 43 ms, 52 ms, 7 s/min, and 35 ms, P < 0.05). Though univariate predictors of CO increment with CRT were Intra-VD, Inter-VD, t-IVT, and D-PEP, only pre-CRT values of CO (P < 0.001), t-IVT (P < 0.001), and D-PEP (P = 0.025) were independent. Conclusion Global, rather than segmental, measures of ventricular dyssynchrony are powerful, independent predictors of clinical response to CRT.
Received March 8, 2006
Revised June 2, 2006
Accepted July 14, 2006
Clinical research
Comparison of segmental and global markers of dyssynchrony in predicting clinical response to cardiac resynchronization
Alison M. Duncan 1 *, Eric Lim 1, Jonathan Clague 1, Derek G. Gibson 1, and Michael Y. Henein 1
Alison M. Duncan, E-mail: a.duncan{at}imperial.ac.uk
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