Key result
CRT in DCM is associated with improved NYHA class and reverse LV remodeling in 80%.
Why the study?
To track reverse cardiac remodeling in patients with dilated cardiomyopathy after CRT in ON and OFF modes, evaluate its clinical implications, and identify factors achieving remodeling.
Does Cardiac Resynchronization Therapy (CRT) improve reverse cardiac remodeling and clinical condition in patients with non-ischemic dilated cardiomyopathy and LBBB?
Observational (n=30)
Does Cardiac Resynchronization Therapy (CRT) improve reverse cardiac remodeling and clinical condition in patients with non-ischemic dilated cardiomyopathy and LBBB?
p-value: p=<0.001
In patients with non-ischemic dilated cardiomyopathy and LBBB, CRT induces significant reverse cardiac remodeling and clinical improvement at 3-6 months, which is strongly predicted by a reduction in QRS duration of at least 20 ms.
Aim: To track the reverse cardiac remodeling in patients with dilated cardiomyopathy post cardiac resynchronization therapy (ON and OFF modes) and its implication on patients clinical condition emphasizing the factors achieving that remodeling. Patients and Methods: 30 patients indicated for the device were enrolled and studied before and three to six months after device insertion by history taking, clinical examination, transthoracic echocardiogram, ECG and six minutes' walk test. Results: 30 patients (23 males and 7 females, mean age (54.50 ± 6.24years) with implanted CRT. All patients were in sinus rhythm, QRS duration ≥120 ms and LBBB with dilated cardiomyopathy (ischemic etiology was excluded by coronary angiography in patients having risk factors for IHD). There was clinical response to CRT as NYHA class improved p < 0.001 and 6 min walk test p < 0.001, electrocardiographically, there were significant differences in HR, PR interval, QRS duration ,axis and morphology between pre and post CRT measurements (P<0.001) and echocardiographic response as LV volume improved in 80%, EF in 76.6% and change (∆QRSD) significantly correlated with changes in NYHA, LVEDD, LVESD, and LVEF. s. Area under the curve was 0.824 for ∆QRSD (p=0.005), ∆QRSD of ≥-20 ms as a cutoff value had high specificity for predicting both clinical and Echocardiographic response. Coronary sinus lead selection and positioning had a major role in achieving that remodeling with best response was shown with the lateral veins (70 % of responders ) and worst response with mid vein ( 65 % of non- responders);Achieving that targeted significant ∆QRSD of ≥-20 ms sometimes required a more than usual programmable VV delay up to 60 ms in some patients. Conclusion: Reverse cardiac remodeling post CRT in patients with DCM in both (CRT ON + OFF modes ) was associated with a significant improvement in patients clinical conditions with subsequent reduction of the incidence of their need to hospital admissions.
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Rabat et al. (2021) conducted an observational in Dilated cardiomyopathy (n=30). Cardiac Resynchronization Therapy (CRT) vs. Pre-CRT baseline was evaluated on Reverse cardiac remodeling (clinical and echocardiographic response) (p=<0.001). Cardiac resynchronization therapy in patients with dilated cardiomyopathy significantly improved NYHA class and 6-minute walk test (P<0.001), with LV volume improving in 80% of patients.
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