Evaluating left ventricular diastolic function and chamber stiffness in heart failure: the impact of cardiac
1Department of Cardiology, Bursa City Hospital, Bursa, Turkey.
Insights
Cardiac resynchronisation therapy (CRT) significantly improves diastolic function and reduces left ventricular (LV) stiffness in heart failure patients. CRT response is not influenced by baseline LV stiffness or diastolic parameters.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Cardiac resynchronisation therapy (CRT) is standard for heart failure with ventricular conduction delay.
- CRT benefits on left ventricular (LV) systolic function are known, but effects on diastolic mechanics are debated.
- Investigating CRT's impact on LV diastolic function and chamber stiffness is crucial.
Purpose of the Study:
- To assess the effects of CRT on LV diastolic function and LV chamber stiffness.
- To determine if baseline LV stiffness or diastolic parameters predict CRT response.
Main Methods:
- 71 heart failure patients were evaluated pre- and post-CRT (6 months) using 2D echocardiography.
- Measured LV volumes, ejection fraction (EF), diastolic parameters (transmitral, tissue Doppler, E/e'), and LV stiffness index (LV-SI).
- CRT response defined as >15% reduction in LV end-systolic volume.
Main Results:
- CRT responders (67.6%) showed significant improvements in diastolic function (E-wave, E/A, E/e' ratios) and reduced LV stiffness (LV-SI decreased by 19.48%).
- Responders had significant LV end-systolic volume reduction (26.3%) and EF improvement (to 40%).
- Non-responders showed no significant changes; baseline parameters did not differ between groups.
Conclusions:
- CRT responders demonstrate significant improvements in LV diastolic function and reduced LV stiffness.
- LV stiffness and diastolic parameters do not appear to influence CRT response.
- CRT effectively enhances diastolic mechanics in responsive heart failure patients.
Background:
Cardiac resynchronisation therapy (CRT) is a standard treatment for heart failure patients with ventricular conduction delay. While its benefits on left ventricular (LV) systolic function are well-established, the effects on LV diastolic mechanics remain controversial. This study aimed to investigate the interactions between CRT therapy, LV diastolic function, and LV chamber stiffness.
Methods:
We evaluated 71 heart failure patients before and six months after CRT using two-dimensional echocardiography. LV volumes, ejection fractions (EF), and diastolic function parameters, including transmitral filling indices, tissue Doppler, and the E/e' ratio, were measured. The LV stiffness index (LV-SI) was calculated using the formula (E / e' lateral) / end-diastolic volume [EDV]). CRT response was defined as a > 15% reduction in LV end-systolic volume.
Results:
Among CRT responders (67.6%), a mean reduction of 26.3% in LV end-systolic volume and a median EF improvement to 40% were observed. Diastolic function improved significantly (E-wave velocity ↓20.9%, E/A ratio ↓16.5%, and E/e' ratio ↓32.7% medial and ↓34.9% lateral; p < 0.001 for all values). The LV stiffness index decreased by 19.48% (p < 0.001). Non-responders showed no significant changes. Baseline parameters for both pulsed-wave and tissue Doppler measurements, as well as LV-SI, showed no significant differences between responders and non-responders.
Conclusion:
This study demonstrates that CRT responders exhibited significant improvements in diastolic function, including measurements of LV filling pressure and active relaxation, as well as a reduction in LV stiffness. Additionally, LV stiffness and diastolic parameters do not appear to influence the response to CRT.
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