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Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography (Articolo in rivista)

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Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography (Articolo in rivista) (literal)

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Ciampi Q.; Pratali L.; Citro R.; Piacenti M.; Villari B.; Picano E. (2009)
Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography
in European journal of heart failure; Oxford University Press, Oxford (Regno Unito)
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In: European Journal of Heart Failure, vol. 11 pp. 489 - 496. Oxford Journals, 2009. (literal)

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Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy, CNR-IFC, Pisa, Division of Cardiology, San Luca Hospital, Salerno, Italy (literal)

Titolo

Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography (literal)

Abstract

Aims The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. Methods and results Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction ?35%, New York Heart Association ?III, and QRS duration ?120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 mg/kg/min: CR was defined as a wall motion score index (WMSI) variation ?0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease ?15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P ¼ 0.001) and in 69% with reverse remodelling (P ¼ 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r ¼ 0.439, P ¼ 0.003) and in WMSI (r ¼ 0.450, P ¼ 0.001), but not with DYS. CR (OR ¼ 6.2, 95% CI ¼ 1.4-27.6, P ¼ 0.015) was the best predictor of response to CRT. Conclusion Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response. (literal)

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