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Updated: Jul 9, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Baseline Doppler parameters are useful predictors of chronic left ventricular reduction in size by cardiac
Martin Stockburger1, Suzanne Fateh-Moghadam, Aischa Nitardy
1Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. martin.stockburger@charite.de
Insights
Left ventricular pre-ejection interval (LVPEI) and interventricular mechanical delay (IVMD) predict positive left ventricular remodeling in patients receiving cardiac resynchronization therapy (CRT). These Doppler parameters help identify CRT responders for improved outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
- Echocardiography
Background:
- Identifying responders to cardiac resynchronization therapy (CRT) in patients with left ventricular (LV) dysfunction and left bundle branch block (LBBB) is challenging.
- Conventional Doppler parameters are explored for their predictive value in CRT response.
Purpose of the Study:
- To evaluate the predictive value of conventional Doppler parameters for identifying responders to CRT.
- To assess the ability of LV pre-ejection interval (LVPEI) and interventricular mechanical delay (IVMD) to predict favorable LV remodeling.
Main Methods:
- Seventy-three patients with LBBB underwent CRT implantation.
- Echocardiographic parameters including LVPEI, IVMD, LV filling time (FT), and myocardial performance index (MPI) were assessed at baseline and after CRT.
- Left ventricular end-diastolic diameter (LVEDD) was measured at baseline and during follow-up.
Main Results:
- A significant reduction in LVEDD was observed post-CRT (66.3 to 59.9 mm, P < 0.001).
- Baseline LVPEI (r = 0.41, P < 0.001) and IVMD (r = 0.34, P = 0.003) correlated with LVEDD reduction.
- An LVPEI >= 140 ms predicted long-term LVEDD reduction with 82% accuracy.
Conclusions:
- LVPEI and IVMD are significant predictors of favorable LV remodeling following CRT.
- These Doppler parameters can aid in identifying patients likely to benefit from CRT.
- Tissue Doppler parameters may further enhance the predictive accuracy of CRT response.
Aims:
The identification of responders to cardiac resynchronization therapy (CRT) in patients with left ventricular (LV) dysfunction and left bundle branch block (LBBB) remains difficult. We aimed to define the predictive value of conventional Doppler parameters.
Methods And Results:
In 73 patients (65 +/- 9 years, 51 male, 36 ischaemic, 37 non-ischaemic cardiomyopathy, QRS 167 +/- 31 ms, LVEF 23 +/- 6%) with LBBB, a CRT device was implanted. LV pre-ejection interval (PEI), interventricular mechanical delay (IVMD), LV filling time (FT), and myocardial performance index (MPI) were assessed at baseline and on optimized CRT. Left ventricular end-diastolic diameter (EDD) was obtained at baseline and after 10.6 +/- 6.7 months. end-diastolic diameter diminished from 66.3 +/- 8.1 to 59.9 +/- 9.6 mm (P < 0.001). Initial LVPEI (r = 0.41, P < 0.001), baseline IVMD (r = 0.34, P = 0.003), acute LVPEI shortening (r = 0.33, P = 0.006), and baseline LVEDD (r = 0.32, P = 0.007) correlated with LVEDD reduction. An LVPEI > or =140 ms had a 82% accuracy to predict long-term LVEDD reduction (sensitivity 86%, specificity 67%, positive and negative predictive values 91 and 56%, respectively). Multivariate analysis solely revealed baseline LVPEI as predictor of LVEDD reduction. FT and MPI correlated only with their respective improvements.
Conclusion:
Left ventricular pre-ejection interval and IVMD predict favourable LV remodelling on CRT. The additional application of tissue Doppler parameters may further increase specificity and negative predictive value.
