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European Journal of Heart Failure 2008 10(5):514-520; doi:10.1016/j.ejheart.2008.03.011
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© 2008 European Society of Cardiology

Effects of cardiac resynchronization therapy on coronary blood flow: Evaluation by transthoracic Doppler echocardiography

Cinzia Valzaniaa,b,*, Fredrik Gadlera,c, Reidar Winterd, Frieder Braunschweiga,c, Lars-Åke Brodine, Petri Gudmundssond, Giuseppe Borianib and Maria J. Erikssond,f

a Department of Medicine, Division of Cardiology, Karolinska Institutet Stockholm, Sweden
b Institute of Cardiology, University of Bologna Bologna, Italy
c Department of Cardiology, Karolinska University Hospital Stockholm, Sweden
d Department of Clinical Physiology, Karolinska University Hospital Stockholm, Sweden
e Department of Medical Engineering, Royal Institute of Technology Stockholm, Sweden
f Department of Molecular Medicine and Surgery, Karolinska Institutet Stockholm, Sweden

* Corresponding author. Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. Tel:. +39 051 344859; fax: +39 051 349858. E-mail address: cinzia.valzania2{at}studio.unibo.it (C. Valzania).


  Abstract

Background: Relatively limited and conflicting data are available on the effects of cardiac resynchronization therapy (CRT) on coronary blood flow (CBF).

Aims: To investigate changes in the left anterior descending coronary artery (LAD) flow under different CRT pacing modes by means of transthoracic Doppler echocardiography (TTE).

Methods: Twenty-two responders to CRT (67±11 years) with idiopathic dilated cardiomyopathy underwent TTE assessment of LAD flow and Tissue Velocity Imaging during 4 programming modes: intrinsic conduction (IC), right ventricular pacing (RV), simultaneous biventricular pacing (BVP), BVP with left ventricular (LV) pre-activation.

Results: Mean coronary flow velocity (CFV) was increased by simultaneous BVP (p=0.0063 vs. IC) and BVP with LV pre-activation (p<0.0001 vs. IC; p=0.027 vs. simultaneous BVP). Peak CFV and LAD flow velocity/time integral were highest during BVP with LV pre-activation. A reduction in septal-to-lateral delay and an increase in peak systolic velocity in the basal septum were observed during simultaneous BVP and BVP with LV pre-activation.

Conclusions: In CRT responders with idiopathic dilated cardiomyopathy, an increase in LAD flow, assessed by TTE, was observed during simultaneous BVP and BVP with LV pre-activation. This was associated with an improvement in regional myocardial contraction and a decrease in intraventricular dyssynchrony.

Key Words: Cardiac resynchronization therapy • Echocardiography • Coronary blood flow

Received October 23, 2007; Revised February 15, 2008; Accepted March 27, 2008


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