Key result
CRT induces reverse remodeling via uniform contraction, potentially explaining long-term benefits better than acute hemodynamics.
Why the study?
The relationship between acute hemodynamic effects of CRT and long-term clinical outcomes is unclear, with evidence suggesting other factors may determine CRT benefit.
This review suggests a paradigm shift in understanding CRT response, emphasizing reverse remodeling over acute hemodynamic effects as the primary driver of long-term benefit.
Answers are grounded in this paper and cite their sources.
Questions acute hemodynamic guidance for CRT; leaves open whether reverse remodeling metrics should drive future device trials and selection.
The hemodynamic, mechanical and electrical effects of cardiac resynchronization therapy (CRT) occur immediate and are lasting as long as CRT is delivered. Therefore, it is reasonable to assume that acute hemodynamic effects should predict long-term outcome. However, in the literature there is more evidence against than in favour of this idea. This raises the question of what factor(s) do relate to the benefit of CRT. There is increasing evidence that dyssynchrony, presumably through the resultant abnormal local mechanical behaviour, induces extensive remodelling, comprising structure, as well as electrophysiological and contractile processes. Resynchronization has been shown to reverse these processes, even in cases of limited hemodynamic improvement. These data may indicate the need for a paradigm shift in order to achieve maximal long-term CRT response.
No takes yet. Share an insight, caveat, or question.
Prinzen et al. (2011) conducted a review in Heart failure with dyssynchrony. Cardiac resynchronization therapy (CRT) was evaluated. Cardiac resynchronization therapy induces reverse remodeling by restoring uniform contraction, which may better explain long-term clinical benefits than acute hemodynamic improvements.
Synapse has enriched 10 related papers. Consider them for comparative context: