Purpose: To describe clinical and echocardiographic characteristics associated with reverse left ventricular (LV) remodeling after 6 months of cardiac resynchronization therapy (CRT) in patients with nonischemic dilated cardiomyopathy. Methods: Twenty-four consecutive patients underwent 2D and 3D echocardiography before and after 6 months of CRT implant. Several echocardiographic parameters including global longitudinal strain (GLS) and 3D mechanical dyssynchrony (MD) index were calculated. CRT response was defined as a decrease in LV end-systolic volume (LVESV) of at least 10% at follow-up. Patients were divided in two groups according to CRT response. Results: Cardiac resynchronization therapy responder (CRTR+) rate was 50%. Nonresponder (CRTR−) patients showed a less significant improvement in NYHA class at follow-up. At baseline, CRTR− presented with higher LV end-diastolic volume (LVEDV) (P = 0.031), LVESV (P = 0.024), lower left ventricular ejection fraction (LVEF) (P = 0.002) and less negative GLS (P = 0.03), and with higher diastolic dysfunction, more impaired right ventricle (RV), and higher pulmonary artery systolic pressure (PASP) (P = 0.002). No significant differences in echocardiographic parameters of MD were found. Univariate determinants of CRTR+ were LVEF (OR = 1.59, CI 95% = 1.13–2.22, P = 0.007) and TAPSE (OR 1.21, CI 95% = 1.024–1.429, P = 0.025). A ROC curve analysis showed a cutoff value of LVEF of 22.15% significantly related to CRTR+ (SE 80%, SP 50%). Conclusions: Our findings suggest that end-stage HF patients, presenting before CRT with LVEF <22.15%, may not benefit from the procedure after 6 months. Mechanical dyssyncronicity did not provide additional information to improve candidate selection.

2D/3D echocardiographic features of patients with reverse remodeling after cardiac resynchronization therapy / Cimino, S.; Maestrini, V.; Cantisani, D.; Petronilli, V.; Filomena, D.; Gatto, M. C.; Birtolo, L. I.; Piro, A.; Lavalle, Carlo; Agati, L.. - In: ECHOCARDIOGRAPHY. - ISSN 0742-2822. - 36:8(2019), pp. 1475-1481. [10.1111/echo.14425]

2D/3D echocardiographic features of patients with reverse remodeling after cardiac resynchronization therapy

Maestrini V.
Co-primo
;
Cantisani D.;Petronilli V.;Filomena D.;Gatto M. C.;Birtolo L. I.;Piro A.;LAVALLE, Carlo;Agati L.
2019

Abstract

Purpose: To describe clinical and echocardiographic characteristics associated with reverse left ventricular (LV) remodeling after 6 months of cardiac resynchronization therapy (CRT) in patients with nonischemic dilated cardiomyopathy. Methods: Twenty-four consecutive patients underwent 2D and 3D echocardiography before and after 6 months of CRT implant. Several echocardiographic parameters including global longitudinal strain (GLS) and 3D mechanical dyssynchrony (MD) index were calculated. CRT response was defined as a decrease in LV end-systolic volume (LVESV) of at least 10% at follow-up. Patients were divided in two groups according to CRT response. Results: Cardiac resynchronization therapy responder (CRTR+) rate was 50%. Nonresponder (CRTR−) patients showed a less significant improvement in NYHA class at follow-up. At baseline, CRTR− presented with higher LV end-diastolic volume (LVEDV) (P = 0.031), LVESV (P = 0.024), lower left ventricular ejection fraction (LVEF) (P = 0.002) and less negative GLS (P = 0.03), and with higher diastolic dysfunction, more impaired right ventricle (RV), and higher pulmonary artery systolic pressure (PASP) (P = 0.002). No significant differences in echocardiographic parameters of MD were found. Univariate determinants of CRTR+ were LVEF (OR = 1.59, CI 95% = 1.13–2.22, P = 0.007) and TAPSE (OR 1.21, CI 95% = 1.024–1.429, P = 0.025). A ROC curve analysis showed a cutoff value of LVEF of 22.15% significantly related to CRTR+ (SE 80%, SP 50%). Conclusions: Our findings suggest that end-stage HF patients, presenting before CRT with LVEF <22.15%, may not benefit from the procedure after 6 months. Mechanical dyssyncronicity did not provide additional information to improve candidate selection.
cardiac resynchronization therapy; left ventricular ejection fraction; NYHA class; reverse remodeling
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2D/3D echocardiographic features of patients with reverse remodeling after cardiac resynchronization therapy / Cimino, S.; Maestrini, V.; Cantisani, D.; Petronilli, V.; Filomena, D.; Gatto, M. C.; Birtolo, L. I.; Piro, A.; Lavalle, Carlo; Agati, L.. - In: ECHOCARDIOGRAPHY. - ISSN 0742-2822. - 36:8(2019), pp. 1475-1481. [10.1111/echo.14425]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1301767
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