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European Journal of Heart Failure Advance Access originally published online on March 26, 2009
European Journal of Heart Failure 2009 11(5):489-496; doi:10.1093/eurjhf/hfp039
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography

Quirino Ciampi1,*, Lorenza Pratali2, Rodolfo Citro3, Marcello Piacenti2, Bruno Villari1 and Eugenio Picano2

1 Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, I-82100 Benevento, Italy
2 CNR, Institute of Clinical Physiology, Via Moruzzi, Pisa, Italy
3 Division of Cardiology, San Luca Hospital, Vallo Della Lucania, Salerno, Italy

* Corresponding author. Tel: +39 0 824 771 269, Fax: +39 0 824 479 35, Email: qciampi{at}iol.it


  Abstract

Aims: The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders.

Methods and results: Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction ≤35%, New York Heart Association ≥III, and QRS duration ≥120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 µg/kg/min: CR was defined as a wall motion score index (WMSI) variation ≥0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease ≥15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P = 0.001) and in 69% with reverse remodelling (P = 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest–stress changes in ESV (r = 0.439, P = 0.003) and in WMSI (r = 0.450, P = 0.001), but not with DYS. CR (OR = 6.2, 95% CI = 1.4–27.6, P = 0.015) was the best predictor of response to CRT.

Conclusion: Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response.

Key Words: Cardiac resynchronization therapy • Contractile reserve • Stress echocardiography • Heart failure

Received November 30, 2008; Revised January 26, 2009; Accepted February 4, 2009


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 Eur J EchocardiogrHome page
Q. Ciampi, B. Petruzziello, M. D. Porta, S. Caputo, V. Manganiello, C. Astarita, and B. Villari
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