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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
The ischemic etiology of heart failure in diabetics limits reverse left ventricular remodeling after cardiac
Osama I I Soliman1, Bas M van Dalen, Dominic A M J Theuns
1Thoraxcenter, Erasmus Medical Center, 3015 CE, Rotterdam, The Netherlands.
Insights
Diabetes mellitus (DM) and ischemic heart failure (HF) etiology predict poor reverse volumetric left ventricular (LV) remodeling after cardiac resynchronization therapy (CRT). Ischemic etiology is the sole independent predictor of suboptimal LV remodeling post-CRT.
Area of Science:
- Cardiology
- Medical Technology
- Heart Failure Research
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF).
- Left ventricular (LV) remodeling is a key factor in HF progression.
- The impact of diabetes mellitus (DM) on CRT outcomes requires further investigation.
Purpose of the Study:
- To compare reverse volumetric LV remodeling after CRT in HF patients with and without DM.
- To identify predictors of poor echocardiographic response to CRT.
Main Methods:
- 130 HF patients undergoing CRT were analyzed.
- Echocardiography, including tissue Doppler, was performed pre- and post-CRT.
- Reverse volumetric LV remodeling was defined as >15% reduction in LV end-systolic volume (ESV).
Main Results:
- Patients with DM had higher rates of hypertension and ischemic HF etiology.
- DM patients showed less improvement in LV ESV and other diastolic function parameters post-CRT.
- Ischemic HF etiology was the only independent predictor of poor reverse volumetric LV remodeling (HR, 2.119; P=.018).
Conclusions:
- Ischemic HF etiology independently predicts poor echocardiographic response to CRT.
- HF patients with DM exhibit poorer CRT response, likely due to a higher prevalence of ischemic etiology.
Aim Of The Study:
The aim of this study was to evaluate reverse volumetric left ventricular (LV) remodeling after cardiac resynchronization therapy (CRT) in patients with heart failure (HF) with vs. without diabetes mellitus (DM).
Methods:
The study comprised 130 consecutive patients with HF (mean age, 61+/-12 years) who underwent CRT. Thirty patients (23%) had DM [mean glycated haemoglobin (HbA(1c)), 7.2+/-3.4%; 13 (43%) on insulin therapy]. Echocardiography, including tissue Doppler measurements, was performed before CRT and between 3 and 6 months after CRT. Echocardiographic response was defined as a >15% reduction in LV end-systolic volume (ESV).
Results:
Patients with DM had more often hypertension (60% vs. 29%, P<.05) and ischemic HF etiology (87% vs. 51%, P<.05), but similar pre-CRT echocardiographic findings. After CRT, patients with DM had equal reductions in QRS duration and lateral-to-septal mechanical delay, but less improvement in LV ESV, mitral annular tissue velocity, the myocardial performance (or Tei) index and the E/E' ratio (ratio of early transmitral peak filling velocity to early mitral annular peak diastolic velocity, an indicator of LV filling pressure). Patients without reverse volumetric LV remodeling had more often DM [hazard ratio (HR), 1.897; P=.042] and an ischemic HF etiology (HR, 2.308; P=.006). An ischemic HF etiology (HR, 2.119; P=.018) was the only independent predictor of poor reverse volumetric LV remodeling.
Conclusion:
Ischemic etiology of HF is an independent predictor of poor echocardiographic response to CRT. Patients with DM and HF have a relatively poor echocardiographic response to CRT most probably due to a high incidence of ischemic etiology of HF.
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