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Ventricular resynchronization: pathophysiology and identification of responders
1Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Reviews in Cardiovascular Medicine
|May 31, 2003
Summary
Biventricular pacing improves heart function in patients with dilated cardiomyopathy and conduction delays. Mechanical dyssynchrony measures, not just QRS duration, better predict patient response to resynchronization therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Dilated cardiomyopathy with intraventricular conduction delay increases risks of heart failure, arrhythmias, and mortality.
- Current resynchronization therapies offer acute benefits but patient response varies, necessitating better candidate selection.
Purpose of the Study:
- To evaluate the predictive accuracy of mechanical dyssynchrony measures versus QRS duration for resynchronization therapy response.
- To identify optimal candidates for biventricular and left ventricular resynchronization pacing.
Main Methods:
- Review of studies utilizing echocardiography, tissue Doppler imaging, and magnetic resonance imaging to assess mechanical dyssynchrony.
- Analysis of correlations between QRS duration and imaging-based dyssynchrony measures with patient outcomes.
Main Results:
- Biventricular and left ventricular resynchronization pacing acutely improve systolic function and energetic efficiency.
- Sustained therapy can reduce chamber dilation and remodeling.
- Mechanical dyssynchrony measures show superior predictive accuracy for patient response compared to QRS duration.
Conclusions:
- Direct measures of mechanical dyssynchrony are more effective than QRS duration for identifying optimal candidates for cardiac resynchronization therapy.
- Improved patient selection can optimize outcomes and resource utilization for heart failure management.