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Updated: May 29, 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
The effect of cardiac resynchronization therapy on left ventricular diastolic function assessed with speckle-tracking
Miriam Shanks1, M Louisa Antoni, Ulas Hoke
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.
Insights
Cardiac resynchronization therapy (CRT) improved left ventricular diastolic function in heart failure patients who responded to treatment. Improvements were seen in responders and those with non-ischemic cardiomyopathy, highlighting CRT
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Left ventricular (LV) diastolic function changes after cardiac resynchronization therapy (CRT) are not fully understood.
- Characterizing these changes in relation to LV reverse remodeling and heart failure etiology is crucial for optimizing CRT outcomes.
Purpose of the Study:
- To evaluate changes in LV diastolic function using speckle-tracking echocardiography after CRT.
- To assess these changes in relation to CRT response (LV remodeling) and heart failure etiology.
Main Methods:
- 192 heart failure patients undergoing CRT implantation were assessed using speckle-tracking echocardiography before and 6 months after implantation.
- LV diastolic function was measured using diastolic strain rate during isovolumic relaxation period (SR(IVR)) and E/SR(IVR) ratio.
- Patients were categorized as responders (≥15% LV end-systolic volume reduction) and by heart failure etiology (ischemic vs. non-ischemic).
Main Results:
- Significant improvements in LV diastolic performance (SR(IVR) and E/SR(IVR)) were observed in CRT responders.
- LV relaxation improved in patients with non-ischemic cardiomyopathy.
- No significant improvement in LV diastolic function was noted in non-responders or patients with ischemic heart disease.
Conclusions:
- Novel diastolic strain rate indices effectively evaluate LV diastolic function changes post-CRT.
- Diastolic function improvement after CRT is primarily observed in responders and those with non-ischemic heart failure etiology.
Aims:
Changes in left ventricular (LV) diastolic function after cardiac resynchronization therapy (CRT) in relation to LV reverse remodelling and heart failure aetiology have not been extensively characterized. The aims of the study were to evaluate changes in LV diastolic function with speckle-tracking echocardiography in relation to: (i) cardiac resynchronization therapy response (LV remodelling) and (ii) heart failure aetiology.
Methods And Results:
A total of 192 heart failure patients undergoing CRT implantation were evaluated. Speckle-tracking echocardiography was performed before and 6 months after implantation and reliable analysis was obtained in 188 patients. Left ventricular diastolic function was assessed by measuring diastolic strain rate during the isovolumic relaxation period (SR(IVR)) and by calculating the ratio of peak transmitral E-wave to SR(IVR) (E/SR(IVR)). Changes in LV diastolic parameters were evaluated in responders and non-responders and in patients with ischaemic and non-ischaemic cardiomyopathy. Response to CRT was defined as ≥15% reduction in LV end-systolic volume at 6 months follow-up. One-hundred and nine patients (58%) were defined as responders. Significant improvements in LV diastolic performance were observed in responders with improvement in SR(IVR) (from 0.14 ± 0.08 to 0.18 ± 0.12 s(-1), P= 0.001) and E/SR(IVR) (from 834 ± 840 to 641 ± 612, P= 0.04). In addition, LV relaxation improved in patients with non-ischaemic aetiology (SR(IVR): from 0.15 ± 0.08 to 0.19 ± 0.13 s(-1), P= 0.004). In contrast, LV relaxation did not improve in non-responders and in patients with ischaemic heart disease.
Conclusions:
Novel diastolic strain rate indices are useful for evaluating changes in LV diastolic function after CRT. Improvement in diastolic function was only observed in responders to CRT and patients with non-ischaemic aetiology.
