Extent of myocardial viability predicts response to biventricular pacing in ischemic cardiomyopathy.
Publication/Presentation Date
11-1-2005
Abstract
BACKGROUND: The clinical response to biventricular pacing is unpredictable, especially in patients with ischemic cardiomyopathy.
OBJECTIVES: The purpose of this study was to prospectively examine the relationship between the extent of myocardial viability and the response to cardiac resynchronization therapy.
METHODS: Twenty-one patients with ischemic left ventricular (LV) dysfunction (left ventricular ejection fraction [LVEF] 21 +/- 5%), New York Heart Association (NYHA) functional class III-IV, and QRS >120 ms received biventricular devices. Myocardial viability was assessed by myocardial contrast echocardiography, and a perfusion score index (PSI) was calculated from summed segmental perfusion scores. LV performance was assessed by echocardiography on the day after implantation and at 6 months.
RESULTS: PSI was closely correlated with acute improvement in LVEF (P = .003, r = 0.65), stroke volume (P = .02, r = 0.54), and end-systolic volume (P = .05, r = -0.49). PSI also correlated with early diastolic LV relaxation (E', P < .05, r = 0.50) and global myocardial performance or Tei index (P = .003, r = 0.63). By multiple linear regression analysis, PSI provided incremental predictive value to the degree of dyssynchrony, measured by tissue Doppler imaging, for predicting improvement in LVEF. At 6 months, PSI remained positively correlated with improvement in ventricular performance and with reduction in LV end-diastolic dimension (P = .003, r = -0.68). PSI also influenced the clinical variables of NYHA class, 6-minute walk distance, quality-of-life score, and number of hospitalizations for heart failure.
CONCLUSION: In patients with ischemic cardiomyopathy, the extent of myocardial viability predicts acute and long-term improvement in LV performance, exercise tolerance, and reduction in LV end-diastolic dimension with biventricular pacing.
Volume
2
Issue
11
First Page
1211
Last Page
1217
ISSN
1547-5271
Published In/Presented At
Hummel, J. P., Lindner, J. R., Belcik, J. T., Ferguson, J. D., Mangrum, J. M., Bergin, J. D., Haines, D. E., Lake, D. E., DiMarco, J. P., & Mounsey, J. P. (2005). Extent of myocardial viability predicts response to biventricular pacing in ischemic cardiomyopathy. Heart rhythm, 2(11), 1211–1217. https://doi.org/10.1016/j.hrthm.2005.07.027
Disciplines
Medicine and Health Sciences
PubMedID
16253911
Department(s)
Department of Medicine
Document Type
Article