Key result
Optimization of cardiac resynchronization therapy by LV dp/dt measurement demonstrated that increased LV dp/dt correlated with increased LVEF (r=0.47, p=0.018), and LVEDD reduction predicted event-free survival.
Why the study?
Does optimization of cardiac resynchronization therapy by measurement of LV dp/dt improve clinical outcomes and echocardiographic parameters in heart failure patients?
Cohort (n=27)
Does optimization of cardiac resynchronization therapy by measurement of LV dp/dt improve clinical outcomes and echocardiographic parameters in heart failure patients?
Optimization of CRT using LV dp/dt is associated with improved LVEF, and subsequent reduction in LVEDD is a significant predictor of event-free survival.
LV dp/dt-guided CRT optimization was associated with LVEF gains; leaves open whether it improves event-free survival in prospective trials.
Background: The relationship between optimization according to left ventricular (LV) dp/dt, changes in LV performance, and prognosis of heart failure patients who undergo cardiac resynchronization therapy (CRT) remains unclear. Methods: We studied 27 consecutive patients who underwent CRT implantation (18 males, 9 females; age, 67.3 ± 8.3 years). We measured LV dp/dt to determine the timing of LV-right ventricular (RV) sequential pacing. Echocardiographic examination was performed before and after the CRT procedure to assess LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Primary endpoints were all-cause death and cardiac hospitalization. Results: An increase in LV dp/dt during CRT was significantly associated with an increase in LVEF (r = 0.47, p = 0.018), but was not associated with a decrease in LVEDD. The mean follow-up period was 14 ± 13 months, and six endpoints were observed. In the control group, no subjects encountered any of the endpoints, and they had higher LVEDD reductions (5.7 ± 8.4 vs. ± 2.5 ± 4.6 mm; p = 0.034) than those in the event group. Cox regression analysis revealed that a reduction in LVEDD was a significant predictor of event-free survival. Conclusions: The measurement of LV dp/dt might be useful for the optimization of CRT. Reductions in LVEDD are necessary to achieve improvements in the long-term prognosis of CRT patients.
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Kabutoya et al. (2011) conducted a cohort in Heart Failure (n=27). CRT optimization by LV dp/dt measurement was evaluated on All-cause death and cardiac hospitalization. Optimization of cardiac resynchronization therapy by LV dp/dt measurement demonstrated that increased LV dp/dt correlated with increased LVEF (r=0.47, p=0.018), and LVEDD reduction predicted event-free survival.
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