Key result
Biventricular pacing significantly improved LVEF from 20.2% to 27.1% (P<0.003) and RVEF from 28.6% to 34.3% (P<0.03) over a 20-month follow-up in patients with dilated cardiomyopathy.
Why the study?
Does biventricular pacing improve long-term ventricular function and resynchronization in patients with dilated cardiomyopathy and asynchrony?
Observational (n=34)
Does biventricular pacing improve long-term ventricular function and resynchronization in patients with dilated cardiomyopathy and asynchrony?
Biventricular pacing provides early and sustained resynchronization and progressive improvement in biventricular function in patients with dilated cardiomyopathy and large electromechanical dyssynchrony.
Biventricular pacing was associated with improved biventricular function in dilated cardiomyopathy; leaves open causal benefit and clinical outcomes pending randomized trials.
Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long-term evolution of ventricular function after BiV. Thirty-four patients (NYHA Class III-IV,65.4 +/- 11 years) with large QRS(179 +/- 18 ms)were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow-up(20 +/- 7 months). We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from 20.2 +/- 8.1%(D0) to27.1%+/- 12.6%(follow-up,P < 0.003 vs D0) and RVEF from 28.6%+/- 13%(D0) to 34.3 +/- 11.5%(follow-up,P < 0.03 vs D0). Inter- (DeltaTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from 68.3 +/- 38 ms(D0) to 13.4 +/- 48.5 ms(D8) and1.8 +/- 39.2 ms(follow-up,P < 0.0001 vs D0); and Tab from 45.8 +/- 64.1 msto-18 +/- 68(D8) and-28.3 +/- 53.6 ms(follow-up,P < 0.0001 vs D0). Early inter- and intraventricular resynchronization (DeltaTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow-up. In DCM patients, BiV resynchronizes ventricles early and in the long-term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV.
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Toussaint et al. (2003) conducted an observational in Dilated cardiomyopathy and asynchrony (n=34). Biventricular pacing (BiV) vs. Baseline (D0) was evaluated on Left ventricular ejection fraction (LVEF) (p=< 0.003). Biventricular pacing significantly improved LVEF from 20.2% to 27.1% (P<0.003) and RVEF from 28.6% to 34.3% (P<0.03) over a 20-month follow-up in patients with dilated cardiomyopathy.
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