Key result
Myocardial viability is linked to significantly better reverse remodeling and LVEF following CRT in ischemic cardiomyopathy.
Why the study?
It was unclear whether patients with post-ischemic dilated cardiomyopathy and myocardial viability benefit more from cardiac resynchronization therapy than those without viability.
Does the presence of myocardial viability improve responsiveness to cardiac resynchronization therapy in patients with post-ischemic dilated cardiomyopathy?
Cohort (n=104)
Does the presence of myocardial viability improve responsiveness to cardiac resynchronization therapy in patients with post-ischemic dilated cardiomyopathy?
The presence of myocardial viability predicts a more favorable clinical, echocardiographic, and neuro-hormonal response to cardiac resynchronization therapy in patients with ischemic dilated cardiomyopathy.
Answers are grounded in this paper and cite their sources.
Viability may identify CRT responders in post-ischemic cardiomyopathy; hypothesis-generating and requires confirmation in randomized studies.
OBJECTIVE: To understand whether patients with post-ischemic dilated cardiomyopathy and myocardial viability (MV) could benefit from cardiac resynchronization therapy (CRT) in terms of clinical, echocardiographic and neuro- hormonal parameters compared to patients without MV. METHODS: One hundred and four consecutive patients were enrolled in a prospective observational cohort study. Using dobutamine stress echocardiography, 2 groups were identified: group A of 51 patients with MV and group B of 53 patients without MV. All patients were implanted with biventricular pacing devices combined with an internal cardioverter-defibrillator. Clinical, echocardiographic and neuro-hormonal parameters were evaluated at baseline and at six month follow-up. Analysis of variance for repeated measures on each variable suggestive of remodeling was performed. We considered responder every patient with: decrease of > 15% in left ventricular volumes and/or improvement in left ventricular ejection fraction of > 5% in addition to NYHA class improvement. RESULTS: All the variables improved in both groups (time effect). Comparing the two groups (group effect), the following variables were significantly better in group A: N-terminal pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic volume after the first week (p=0.035). RR occurred at the first week after CRT only in Group A and was maintained for all the time of this study. The maximum difference of the decrease of left ventricular volumes between the two groups occurred after the first week (p<0.001). CONCLUSION: Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT.
No takes yet. Share an insight, caveat, or question.
Pugliese et al. (2012) conducted a cohort in Post-ischemic dilated cardiomyopathy (n=104). Myocardial viability vs. No myocardial viability was evaluated on Reverse remodeling (p=0.007). In patients with post-ischemic dilated cardiomyopathy undergoing CRT, the presence of myocardial viability was associated with significantly better reverse remodeling (P=0.007) and LVEF (P=0.009).
Synapse has enriched 10 related papers. Consider them for comparative context: