What question did this study set out to answer?

To investigate the effect of biventricular pacing therapy on left ventricular reverse remodeling and elucidate the underlying mechanical mechanisms of clinical and cardiac improvement.

January 29, 2002CirculationOpen Access

Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure

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Why the study?

Does biventricular pacing therapy improve reverse remodeling and cardiac synchrony in patients with advanced heart failure and wide QRS complexes?

Population

25 patients with NYHA class III to IV heart failure and electrocardiographic wave complex duration >140 ms

Comparison

Biventricular pacing therapy for up to 3 months vs Baseline and pacing withheld for 4 weeks

Design

Cohort

Follow-up

3 months (plus 4 weeks pacing withheld)

Authors

CYCheuk‐Man YuHeart Failure / Cardiomyopathy ECElaine ChauMayo Clinic JSJohn E. SandersonHeart Failure & Transplant

Discussion

Member takes

Implication

Biventricular pacing was associated with reverse remodeling in advanced HF; hypothesis-generating pending randomized confirmation.

Key Points

To investigate the effect of biventricular pacing therapy on left ventricular reverse remodeling and elucidate the underlying mechanical mechanisms of clinical and cardiac improvement.
Assessed 25 patients with NYHA class III to IV heart failure and QRS duration >140 ms receiving biventricular pacing serially up to 3 months and after withholding pacing for 4 weeks.
Utilized tissue Doppler echocardiography with a 12-segment model (6-basal, 6-mid) to measure regional time to peak sustained systolic contraction.
Biventricular pacing for 3 months significantly decreased left ventricular end-diastolic volume (205±68 vs 168±67 mL, P<0.01) and end-systolic volume (162±54 vs 122±42 mL, P<0.01), with concomitant improvements in ejection fraction, dP/dt, and 6-minute walk distance.
Regional left ventricular synchrony improved via a reduced standard deviation of contraction timing across segments (37.7±10.9 vs 29.3±8.3 ms, P<0.05) and shortened isovolumic contraction time (122±57 vs 82±36 ms, P<0.05).
Observed clinical and structural reverse remodeling benefits were pacing dependent, demonstrating progressive loss upon temporary withdrawal of pacing therapy.

Structured PICO

Does biventricular pacing therapy improve reverse remodeling and cardiac synchrony in patients with advanced heart failure and wide QRS complexes?

Population

25 patients with NYHA class III to IV heart failure and electrocardiographic wave complex duration >140 ms

Intervention

Biventricular pacing therapy for up to 3 months

Comparator

Baseline (pre-pacing) and pacing withheld for 4 weeks

Outcome

Reverse remodeling and underlying mechanisms assessed by Tissue Doppler echocardiography (including ejection fraction, LV volumes, and time to peak sustained systolic contraction)surrogate

Biventricular pacing reverses left ventricular remodeling and improves cardiac function in advanced heart failure, primarily by improving left ventricular mechanical synchrony.

Cite This Study

Yu et al. (2002) studied this question.

synapsesocial.com/papers/69f29d161b51e2fbf01873f7 https://doi.org/10.1161/hc0402.102623

Topics

Heart failure HFrEF treatment

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Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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