PMID- 17984216
OWN - NLM
STAT- MEDLINE
DCOM- 20080807
LR  - 20081210
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 94
IP  - 8
DP  - 2008 Aug
TI  - Diastolic filling pattern and left ventricular diameter predict response and 
      prognosis after cardiac resynchronisation therapy.
PG  - 1026-31
AB  - OBJECTIVE: To investigate predisposing factors for cardiac resynchronisation 
      therapy (CRT) response. DESIGN: Single-centre study. SETTING: University hospital 
      in Germany. PATIENTS: 122 consecutive patients with heart failure (mean (SD) age 
      65 (11) years; ischaemic/non-ischaemic 41%/55%; New York Heart Association (NYHA) 
      class 3.1 (0.3); left ventricular ejection fraction 24.4 (8.1)%; QRS width 170 
      (32) ms, quality of life (QoL) 43.5 (19.2)) with an indication for CRT and 
      demonstrated left ventricular dyssynchrony by echocardiography including tissue 
      Doppler imaging. INTERVENTIONS: Besides laboratory testing of clinical variables, 
      results of ECG, echocardiography including tissue Doppler imaging, invasive 
      haemodynamics, measures of QoL and of exercise capacity were obtained before CRT 
      implantation and during follow-up. MAIN OUTCOME MEASURE: Responders were 
      predefined as patients with improvement by one or more NYHA functional class or 
      reduction of left ventricular end-systolic volume by 10% or more during 
      follow-up. Mean (SD) follow-up was 418 (350) days. RESULTS: Overall, 70.5% of 
      patients responded to CRT. Responders had a significantly improved survival 
      compared with non-responders (96.2% vs 45.5%, log-rank p<0.001). On univariate 
      analysis, left ventricular end-diastolic diameter, left ventricular end-systolic 
      diameter (LVESD), E/A ratio, a restrictive filling pattern, mean pulmonary artery 
      pressure, pulmonary capillary pressure, N-terminal pro-brain natriuretic peptide 
      and Vo(2)max were significant predictors of outcome. On multivariate analyses, 
      LVESD (p = 0.009; F = 7.83), pulmonary capillary pressure (p = 0.015, F = 6.61) 
      and a restrictive filling pattern (p = 0.026, F = 5.707) remained significant 
      predictors of response. CONCLUSIONS: Despite treatment according to present 
      guidelines nearly 30% of patients had no benefit from CRT treatment in a clinical 
      setting. On multivariate analyses, patients with an increased left ventricular 
      end-systolic diameter and concomitant diastolic dysfunction had a significantly 
      worse outcome.
FAU - Gradaus, R
AU  - Gradaus R
AD  - Department of Cardiology and Angiology, University Hospital Munster, Germany. 
      gradaus@uni-muenster.de
FAU - Stuckenborg, V
AU  - Stuckenborg V
FAU - Loher, A
AU  - Loher A
FAU - Kobe, J
AU  - Kobe J
FAU - Reinke, F
AU  - Reinke F
FAU - Gunia, S
AU  - Gunia S
FAU - Vahlhaus, C
AU  - Vahlhaus C
FAU - Breithardt, G
AU  - Breithardt G
FAU - Bruch, C
AU  - Bruch C
LA  - eng
PT  - Journal Article
DEP - 20071105
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
CIN - Heart. 2008 Nov;94(11):1496; author reply 1496. PMID: 18931160
MH  - Aged
MH  - *Cardiac Pacing, Artificial
MH  - Diastole
MH  - Echocardiography, Doppler/methods
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/complications/physiopathology/*therapy
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/diagnosis/etiology/physiopathology/*therapy
EDAT- 2007/11/07 09:00
MHDA- 2008/08/08 09:00
CRDT- 2007/11/07 09:00
PHST- 2007/11/07 09:00 [pubmed]
PHST- 2008/08/08 09:00 [medline]
PHST- 2007/11/07 09:00 [entrez]
AID - hrt.2007.126193 [pii]
AID - 10.1136/hrt.2007.126193 [doi]
PST - ppublish
SO  - Heart. 2008 Aug;94(8):1026-31. doi: 10.1136/hrt.2007.126193. Epub 2007 Nov 5.