© 2003 European Society of Cardiology
Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging
a Echocardiography Laboratory Hopital Cardiologique du Haut-Leveque, Pessac Cedex 33600, France
b Clinical Electrophysiology and Cardiac Pacing Department Hopital Cardiologique du Haut-Leveque, Pessac Cedex 33600, France
* Corresponding author. Present address: Department of Echocardiography, Hôpital Cardiologique du Haut-Lévêque, 19, Avenue de Magellan, Pessac Cedex 33604, France. Tel.: +33-5-57-65-65-65x75516; fax: +33-5-57-65-50-12. E-mail address: stephane.lafitte{at}chu-bordeaux.fr
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Abstract |
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We sought to assess right, left and biventricular pacing effects on myocardial function by using pulsed-Doppler tissue imaging (DTI) and automated border detection (ABD) techniques which provide electromechanical delay (EMD) assessment of the different left ventricular walls.
Methods: 15 patients (67±7 years) with drug-resistant primitive dilated cardiomyopathy and QRS
140 ms received a pacemaker for multisite ventricular pacing. Echocardiography was performed after 1 month of biventricular pacing (BVP). Echocardiographic measurements were recorded during spontaneous rhythm (SpR), right ventricular pacing (RVP), left ventricular pacing (LVP) and BVP.
Results: LV ejection fraction was statistically similar between the four rhythms. BVP showed a significant EMD decrease for the lateral LV wall vs. SpR, RVP and even LVP. LVP resulted in significantly longer aortic pre-ejection time vs. BVP while the EMD temporal dispersion (time between the shortest regional EMD and the longest one) was similar in the two modes.
Conclusions: BVP and LVP substantially reduce the EMD temporal dispersion of the four LV walls, but with a longer aortic pre-ejection time for LVP. In RVP, LVP and BVP, the septal LV wall is always activated later than during SpR. BVP and LVP are associated with a mitral regurgitation reduction.
Key Words: Cardiac resynchronization therapy • Left ventricular pacing • Tissue Doppler imaging • Heart failure • Ventricular asynchrony
Received June 26, 2003; Revised July 31, 2003; Accepted October 13, 2003
The first two authors contributed equally to this work.
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