Prediction of long‐term outcome of cardiac resynchronization therapy by acute pressure–volume loop measurements. (March 2013)

• Record Type: Journal Article
• Authors: de, Gerben J.; Allaart, Cornelis P.; Kleijn, Sebastiaan A.; Delnoy, Peter Paul H.M.; Wu, LiNa; Hendriks, Matthijs L.; Bronzwaer, Jean G.F.; van, Albert C.; de, Carel C.
• Is Part Of: European journal of heart failure. Volume 15:Number 3(2013)
• Page Start: 299
• Page End: 307
• Publication Date: 2013-03
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1093/eurjhf/hfs190
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main" id="ejhfhfs190-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhfhfs190-sec-0001" sec-type="section"> <title>Aims</title> <p>Invasive assessment of acute haemodynamic response to biventricular pacing has been proposed as a tool to determine individual response and to optimize the effects of CRT. However, the long‐term results of this approach have been poorly studied. The present study relates acute haemodynamic effects of CRT to long‐term outcome.</p> </sec> <sec id="ejhfhfs190-sec-0002" sec-type="section"> <title>Methods and results</title> <p>Forty‐one patients were analysed in the present study. During temporary biventricular pacing before implantation, acute changes in LV pump function were assessed by pressure–volume loop measurements and related to long‐term response after CRT. In the study population [30 (71%) men, NYHA class 2.9 ± 0.4, EF 28 ± 7%, QRS 150 ± 25 ms], baseline mean stroke work (SW) and d<italic>P</italic>/d<italic>t</italic><sub>max</sub> were 4.6 ± 2.6 L ×mmHg and 874 ± 259 mmHg/s, respectively. During biventricular pacing, mean SW and d<italic>P</italic>/d<italic>t</italic><sub>max</sub> increased significantly by 43 ± 39% (+ 2.2 ± 2.4 L × mmHg, <italic>P</italic> < 0.001) and 13 ± 18% (+ 96 ± 136 mmHg/s, <italic>P</italic> < 0.001), respectively. In long‐term responders (<italic>n</italic> = 29, 71%) compared with non‐responders (<italic>n</italic> = 12, 29%), the acute increase in SW was significantly higher (+57 ±33% vs. + 10 ±30%, <italic>P</italic> < 0.001), whereas the acute increase in d<italic>P</italic>/d<italic>t</italic><sub>max</sub> was not significantly different between responders and non‐responders (+ 15 ±18% vs. 6 ±15%, <italic>P</italic> = 0.139). Receiver operating characteristic (ROC) curve analysis indicated that SW was superior to d<italic>P</italic>/d<italic>t</italic><sub>max</sub>, QRS duration and LV dyssynchrony in prediction of response to CRT. A cut‐off value for SW of 20% yielded a sensitivity of 90% and specificity of 75% to predict reverse remodelling at 6 months.</p> </sec> <sec id="ejhfhfs190-sec-0003" sec-type="section"> <title>Conclusion</title> <p>Invasive assessment of acute haemodynamics is a reliable tool to determine individual response to CRT. An acute increase in SW predicts long‐term response to CRT with a higher accuracy than an acute increase in d<italic>P</italic>/d<italic>t</italic><sub>max</sub>, baseline QRS duration, and degree of LV mechanical dyssynchrony.</p> </sec> </abstract>