PMID- 16567291
OWN - NLM
STAT- MEDLINE
DCOM- 20060921
LR  - 20161222
IS  - 1547-5271 (Print)
IS  - 1547-5271 (Linking)
VI  - 3
IP  - 4
DP  - 2006 Apr
TI  - The benefit of upgrading chronically right ventricle-paced heart failure patients 
      to resynchronization therapy demonstrated by strain rate imaging.
PG  - 435-42
AB  - BACKGROUND: RV pacing induces conduction delay (CD), mechanical dyssynchrony, and 
      increased morbidity in patients with HF. CRT improves HF symptoms and survival, 
      but sparse data exist on its direct effect on chronically RV-paced HF patients. 
      OBJECTIVES: To assess the benefit of cardiac resynchronization therapy (CRT) in 
      chronically right ventricle (RV)-paced heart failure (HF) patients. METHODS: We 
      studied 12 consecutive patients with class III HF who had a previously implanted 
      pacemaker or implantable cardioverter-defibrillator. These individuals were 
      chronically RV paced and referred for upgrade to a biventricular device by their 
      primary cardiologists. Tissue Doppler and strain rate imaging (TDI and SRI, 
      respectively) were performed immediately before each upgrade and 4-6 weeks 
      afterward to quantify changes in regional wall motion and synchrony with CRT. 
      RESULTS: CRT significantly reduced the mean QRS duration (205 ms to 156 ms; 
      P<.0001), and it increased the ejection fraction (30.7%+/-5.1% to 35.8%+/-5.1%; 
      P<.01). Left ventricular end-systolic and end-diastolic dimensions were also 
      significantly reduced. Clinically, patients improved by an average of one New 
      York Heart Association (NYHA) functional class after upgrade (P = .006). The 
      parameter exhibiting greatest improvement was the coefficient of variation (CoV: 
      standard deviation/mean) of time to peak systolic strain rate, a marker of 
      ventricular dyssynchrony, which decreased from 34.3%+/-13.0% to 19.0%+/-6.6% 
      (P<.01). Reduction in CoV of time to peak systolic strain rate was maximally seen 
      in the midventricle (38.2%+/-19.6% to 16.5%+/-9.7%; P<.01). CONCLUSIONS: 
      Upgrading chronically RV-paced HF patients to CRT improves global and regional 
      systolic function. TDI and SRI provide compelling evidence that this benefit 
      parallels that seen in HF patients with CD unrelated to RV pacing, which implies 
      that biventricular pacing synchronizes mechanical activation in different 
      myocardial regions in patients upgraded from RV pacing as well.
FAU - Eldadah, Zayd A
AU  - Eldadah ZA
AD  - Division of Cardiology, Department of Medicine, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA. zeldadah@jhmi.edu
FAU - Rosen, Boaz
AU  - Rosen B
FAU - Hay, Ilan
AU  - Hay I
FAU - Edvardsen, Thor
AU  - Edvardsen T
FAU - Jayam, Vinod
AU  - Jayam V
FAU - Dickfeld, Timm
AU  - Dickfeld T
FAU - Meininger, Glenn R
AU  - Meininger GR
FAU - Judge, Daniel P
AU  - Judge DP
FAU - Hare, Joshua
AU  - Hare J
FAU - Lima, Joao B
AU  - Lima JB
FAU - Calkins, Hugh
AU  - Calkins H
FAU - Berger, Ronald D
AU  - Berger RD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - *Cardiac Pacing, Artificial
MH  - Chronic Disease
MH  - Defibrillators, Implantable
MH  - *Echocardiography
MH  - Female
MH  - Heart Conduction System/diagnostic imaging/physiopathology/surgery
MH  - Heart Failure/diagnostic imaging/*physiopathology/*therapy
MH  - Heart Ventricles/diagnostic imaging/physiopathology/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/physiopathology/therapy
MH  - Myocardial Contraction
MH  - Pacemaker, Artificial
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/diagnostic imaging/surgery
MH  - Ventricular Function, Left
MH  - Ventricular Remodeling
EDAT- 2006/03/29 09:00
MHDA- 2006/09/22 09:00
CRDT- 2006/03/29 09:00
PHST- 2005/05/27 00:00 [received]
PHST- 2005/12/08 00:00 [accepted]
PHST- 2006/03/29 09:00 [pubmed]
PHST- 2006/09/22 09:00 [medline]
PHST- 2006/03/29 09:00 [entrez]
AID - S1547-5271(05)02456-2 [pii]
AID - 10.1016/j.hrthm.2005.12.003 [doi]
PST - ppublish
SO  - Heart Rhythm. 2006 Apr;3(4):435-42. doi: 10.1016/j.hrthm.2005.12.003.