© 2002 European Society of Cardiology
Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure
a Siyami Ersek Cardiovascular and Thoracic Surgery Center, Cardiology Clinic Istanbul, Turkey
b Trakya University, School of Medicine, Cardiology Department Edirne, Turkey
* Corresponding author. Murat Reis mah Demsel Sitesi C:21, 81200 Ba
larba
, 
stanbul, Turkey; Tel.: +90-216-4928303; fax: +90-216-4180619. E-mail address: enisoguz1{at}superonline.com
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Abstract |
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Background: Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy.
Aims: To assess whether the long-term benefit could be predicted from the echocardiographic parameters.
Methods and Results: Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n=11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n=5) failed to improve at follow-up (7.6±5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256±105 vs. 358±115, P=0.14 and 564±199 vs. 468±117, P=0.44, respectively), the QRS width (149±15 vs. 175±24 ms, P=0.05) and the dMR (343±70 vs. 443±49 ms, P=0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P=0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468±117 to 676±216 mmHg/s vs. from 564±199 to 483±94, P=0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness.
Conclusion: Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing.
Key Words: Biventricular pacing • Echocardiography • Heart failure
Received February 15, 2001; Revised May 22, 2001; Accepted August 10, 2001