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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
Echo/Doppler-derived time intervals are able to predict left ventricular reverse remodeling after cardiac
Cristina M Porciani1, Alessio Lilli, Francesco Cappelli
1Department of Heart and Vessels, University of Florence, Florence, Italy.
Insights
Echocardiogram-derived indices can predict which patients will respond to cardiac resynchronization therapy (CRT). These measurements, reflecting isovolumic phases, identify patients likely to experience reverse remodeling after CRT.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Identifying patients who will benefit from CRT is crucial for effective treatment.
- Echocardiography and Doppler are non-invasive imaging techniques used to assess cardiac function.
Purpose of the Study:
- To evaluate the predictive value of echocardiogram/Doppler derived indices for identifying cardiac resynchronization therapy (CRT) responders.
- To assess if indices reflecting isovolumic phases of the cardiac cycle can predict CRT response.
Main Methods:
- 105 patients undergoing CRT had echo/Doppler parameters measured at baseline and 6 months post-therapy.
- Key parameters included myocardial performance index (MPI) and total isovolumic time (t-IVT).
- Responders were defined by a ≥15% reduction in left ventricular end-systolic volume.
Main Results:
- Responders had significantly higher baseline t-IVT and MPI compared to non-responders.
- Receiver operating characteristic curve analysis indicated t-IVT and MPI could predict CRT response with high sensitivity and specificity.
- Baseline t-IVT showed a strong correlation with the reduction in end-systolic volume.
Conclusions:
- Echocardiogram/Doppler derived indices reflecting isovolumic contraction and relaxation abnormalities can predict CRT response.
- These indices are valuable tools for identifying patients likely to achieve reverse remodeling after CRT.
Aim:
We evaluated the predictive value of echo/Doppler derived indices, which reflect the duration of the isovolumic phases of the cardiac cycle, in identifying cardiac resynchronization therapy (CRT) responders.
Methods And Results:
In 105 patients before and 6 months after CRT the following echo/Doppler parameters were evaluated: myocardial performance index (MPI) as the sum of isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT) divided by ejection time; total isovolumic time (t-IVT) as the sum of IVCT and IVRT divided by the RR interval; and standard deviation of the time to systolic peak velocity (Ts-SD) as asynchrony index. After 6 months, patients were defined responders according to 15% left ventricle (LV) end-systolic volume reduction or more. At baseline, responders (53.3%) had higher t-IVT and MPI than nonresponders (0.30 +/- 0.06 versus 0.22 +/- 0.05, P < 0.0001 and 1.01 +/- 0.27 versus 0.73 +/- 0.19, P < 0.0001, respectively). Receiving operating characteristic curve analysis showed that both t-IVT (80.3% sensitivity and 83.7% specificity, cut-off = 0.263) and MPI (78.6% sensitivity and 81.6% specificity, cut-off = 0.84) could predict CRT response. Baseline t-IVT correlated well to end-systolic volume reduction (r = -0.56, P < 0.00001).
Conclusion:
Echo/Doppler derived indices, describing physiologic abnormalities of the isovolumic contraction and relaxation phase, are able to predict CRT-induced reverse remodeling.
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