BACKGROUND: The identification of responders remains challenging in cardiac resynchronization therapy (CRT). Pressure-volume relationship (PVR) is a method to evaluate left ventricular myocardial contractility during stress. The aim of the study was to assess the role of PVR to identify responders to CRT. METHODS: Seventy-two patients (57% with ischemic etiology) referred to CRT: ejection fraction ≤ 35%, New York Heart Association ≥ III and QRS duration ≥ 120 milliseconds, underwent dobutamine stress echocardiography (up to 40 μg/kg per minute). PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dobutamine stress echocardiography. Responders were identified by clinical and/or echocardiographic (end-systolic volume decrease ≥ 15%) follow-up criteria. We divided retrospectively the patient population into 2 groups, accordingly to the presence of myocardial contractile reserve that was set at the value of PVR (0.72 mm Hg/mL per square meter) obtained by a receiver operating characteristic analysis. RESULTS: During a median follow-up of 12 months, 8 patients (11%) died. Patients with lower PVR, showed higher brain natriuretic peptide levels (853 ± 1211 vs 342 ± 239, P = .044) larger left ventricular end-diastolic (196 ± 82 mL vs 152 ± 39 mL, P = .005) and end-systolic (147 ± 66 vs 112 ± 30 mL, P = .006) volumes. Intraventricular dyssynchrony was similar in the 2 groups (88 ± 45 vs 70 ± 32 milliseconds, P = .175). Patients with higher PVR presented a larger incidence of clinical (86% vs 46% P < .001), and echocardiographic responders to CRT (79% vs 40%, P = .002). Event-free survival was significantly better in patients with higher PVR (log rank = 5.78, P = .01). CONCLUSION: Patients with preserved contractility, assessed by PVR during stress echocardiography show a favor clinical outcome and left ventricular reverse remodeling after CRT. In particular, PVR may have a significant clinical role in patients undergoing CRT, providing critical information for risk stratification.
BACKGROUND: The identification of responders remains challenging in cardiac resynchronization therapy (CRT). Pressure-volume relationship (PVR) is a method to evaluate left ventricular myocardial contractility during stress. The aim of the study was to assess the role of PVR to identify responders to CRT. METHODS: Seventy-two patients (57% with ischemic etiology) referred to CRT: ejection fraction ≤ 35%, New York Heart Association ≥ III and QRS duration ≥ 120 milliseconds, underwent dobutamine stress echocardiography (up to 40 μg/kg per minute). PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dobutamine stress echocardiography. Responders were identified by clinical and/or echocardiographic (end-systolic volume decrease ≥ 15%) follow-up criteria. We divided retrospectively the patient population into 2 groups, accordingly to the presence of myocardial contractile reserve that was set at the value of PVR (0.72 mm Hg/mL per square meter) obtained by a receiver operating characteristic analysis. RESULTS: During a median follow-up of 12 months, 8 patients (11%) died. Patients with lower PVR, showed higher brain natriuretic peptide levels (853 ± 1211 vs 342 ± 239, P = .044) larger left ventricular end-diastolic (196 ± 82 mL vs 152 ± 39 mL, P = .005) and end-systolic (147 ± 66 vs 112 ± 30 mL, P = .006) volumes. Intraventricular dyssynchrony was similar in the 2 groups (88 ± 45 vs 70 ± 32 milliseconds, P = .175). Patients with higher PVR presented a larger incidence of clinical (86% vs 46% P < .001), and echocardiographic responders to CRT (79% vs 40%, P = .002). Event-free survival was significantly better in patients with higher PVR (log rank = 5.78, P = .01). CONCLUSION:Patients with preserved contractility, assessed by PVR during stress echocardiography show a favor clinical outcome and left ventricular reverse remodeling after CRT. In particular, PVR may have a significant clinical role in patients undergoing CRT, providing critical information for risk stratification.
Authors: Eugenio Picano; Quirino Ciampi; Rodolfo Citro; Antonello D'Andrea; Maria Chiara Scali; Lauro Cortigiani; Iacopo Olivotto; Fabio Mori; Maurizio Galderisi; Marco Fabio Costantino; Lorenza Pratali; Giovanni Di Salvo; Eduardo Bossone; Francesco Ferrara; Luna Gargani; Fausto Rigo; Nicola Gaibazzi; Giuseppe Limongelli; Giuseppe Pacileo; Maria Grazia Andreassi; Bruno Pinamonti; Laura Massa; Marco A R Torres; Marcelo H Miglioranza; Clarissa Borguezan Daros; José Luis de Castro E Silva Pretto; Branko Beleslin; Ana Djordjevic-Dikic; Albert Varga; Attila Palinkas; Gergely Agoston; Dario Gregori; Paolo Trambaiolo; Sergio Severino; Ayana Arystan; Marco Paterni; Clara Carpeggiani; Paolo Colonna Journal: Cardiovasc Ultrasound Date: 2017-01-18 Impact factor: 2.062