http://www.cnr.it/ontology/cnr/individuo/prodotto/ID109091

Identification of responders to CRT by stress echo: no contractile reserve, no party (Abstract in rivista)

Type

Abstract in rivista (Classe)
Prodotto della ricerca (Classe)

Label

Identification of responders to CRT by stress echo: no contractile reserve, no party (Abstract in rivista) (literal)

Anno

2007-01-01T00:00:00+01:00 (literal)

Alternative label

Pratali L.; Corciu A.; Frassi F.; Piacenti M.; Morales M. A.; Picano E. (2007)
Identification of responders to CRT by stress echo: no contractile reserve, no party
in European Journal of Echocardiography, 2007
(literal)

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Pratali L.; Corciu A.; Frassi F.; Piacenti M.; Morales M. A.; Picano E. (literal)

Convegno

European Journal of Echocardiography (literal)

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In: European Journal of Echocardiography, vol. December Supplement Oxford Journals, 2007. (literal)

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Background: Cardiac resynchronization therapy (CRT) is increasingly used, but the identification of \"responders\" remains challenging. Aim: to assess the value of inotropic reserve during pharmacological echo stress to identify responders. Materials and methods: We enrolled 32 patients (age 69±9 years; 9 females) referred to CRT, all with LV ejection fraction (LVEF) d35n %, NYHA eIIb and QRS duration e130 milliseconds. Twenty-two patients showed echocardiographic criteria for dyssynchrony (at least one of M-mode, Tissue Doppler, or live 3D echo criteria). All patients underwent pharmacological stress echo (dobutamine, up to 40 mcg/Kg/min in 29, dipyridamole 0.84 mg/kg 10 min, in 3). Patients were considered with contractile response if variation of WMSI (from 1=normal, to 4=dyskinetic, 17 segment model of left ventricle) stress-rest (delta WMSI) was e0.20. \"Responders\" to CRT were defined at 6 months follow-up as survivors with NYHA class improvement e1 grade and without new hospital admission for acute heart failure. Results: In the follow-up (median=20 months), 16 patients were responders to CRT (Group I) and 16 non-responders (Group II). Responders showed a wider QRS (I=162±25 vs. II=142 ±27 msec; p .044) and a greater delta WMSI (I=0.34±0.25 vs. II= 0.15±0.18; p=.021). At individual patient analysis, inotropic reserve was more often associated with a favourable clinical outcome (see figure) whereas dyssynchrony criteria by echocardiography were equally present in the two groups (I=12/16 vs. II=10/16, p=ns). In the follow-up there were 5 deaths, all in group II. Conclusion: Patients with contractile reserve during stress echo show a favourable clinical response to CRT. This parameter shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response: no muscle, no party! (literal)

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