Cardiac resynchronization therapy yielded a significantly higher response rate in non-ischemic versus ischemic cardiomyopathy patients, with restrictive filling independently predicting poor response.
Cohort (n=104)
Does diastolic function explain the different responses to cardiac resynchronization therapy between ischemic and non-ischemic cardiomyopathy patients?
Severe diastolic dysfunction, particularly a restrictive filling pattern, is more common in ischemic cardiomyopathy and independently predicts a poorer response to cardiac resynchronization therapy.
OBJECTIVES:: To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes. METHODS:: The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters. RESULTS:: The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy. CONCLUSIONS:: This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.
Wang et al. (Sun,) conducted a cohort in Heart failure (n=104). Cardiac resynchronization therapy vs. Ischemic vs non-ischemic cardiomyopathy was evaluated on Response to cardiac resynchronization therapy evaluated using clinical symptoms and echocardiography parameters. Cardiac resynchronization therapy yielded a significantly higher response rate in non-ischemic versus ischemic cardiomyopathy patients, with restrictive filling independently predicting poor response.