PMID- 18803571
OWN - NLM
STAT- MEDLINE
DCOM- 20090316
LR  - 20090105
IS  - 1540-8167 (Electronic)
IS  - 1045-3873 (Linking)
VI  - 20
IP  - 1
DP  - 2009 Jan
TI  - The impact of myocardial viability on the clinical outcome of cardiac 
      resynchronization therapy.
PG  - 50-7
LID - 10.1111/j.1540-8167.2008.01294.x [doi]
AB  - INTRODUCTION: Around 30% of patients do not respond to cardiac resynchronization 
      therapy (CRT). Nonischemic cardiomyopathy has been identified as an independent 
      predictor of response to CRT, probably due to the absence of compact scar. 
      METHODS AND RESULTS: The relationship between cardiac scar, ischemia, and 
      hibernation (both at the left-ventricular pacing site and as a total burden) and 
      response to CRT was studied in patients with ischemic cardiomyopathy using the 
      perfusion-viability positron emission tomography (PET) test. Sixty-six patients 
      with ischemic cardiomyopathy and traditional criteria for CRT were included. All 
      patients underwent PET scan prior to CRT. Using PET, the amount and location of 
      scarred, ischemic, and hibernating myocardium were characterized. No 
      revascularization was indicated. Responders were defined by an improvement of 
      left-ventricular ejection fraction (LVEF) >or= 5% and/or New York Heart 
      Association (NYHA) class >or= 1 degree. During a mean follow-up of 26.2 +/- 22.2 
      months, there was a significant improvement in NYHA class and reverse remodeling 
      in patients with the LV lead inserted remotely from the scar. However, reverse 
      remodeling of a similar degree was present also in patients with extensive 
      scarring including the lateral wall. The presence of ischemia, hibernation, or 
      nontransmural scar at the pacing-site did not significantly modify the outcome of 
      CRT as compared with viable myocardium. There were only 38% of CRT-nonresponders. 
      Neither the extent of scar, ischemia, hibernation, or viability predicted outcome 
      or mortality. Twenty patients died during the follow-up, one patient underwent 
      heart transplant. CONCLUSIONS: At follow-up, response to CRT is observed 
      regardless of the presence of extensive scarring. Left ventricular (LV) pacing at 
      sites with ischemia, hibernation, or nontransmural scar does not appear to modify 
      the effect of CRT as compared to viable tissue.
FAU - Riedlbauchova, Lucie
AU  - Riedlbauchova L
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. 
      luri@medicon.cz
FAU - Brunken, Richard
AU  - Brunken R
FAU - Jaber, Wael A
AU  - Jaber WA
FAU - Popova, Lucie
AU  - Popova L
FAU - Patel, Dimpi
AU  - Patel D
FAU - Lanska, Vera
AU  - Lanska V
FAU - Civello, Kenneth
AU  - Civello K
FAU - Cummings, Jennifer
AU  - Cummings J
FAU - Burkhardt, J David
AU  - Burkhardt JD
FAU - Saliba, Walid
AU  - Saliba W
FAU - Martin, David
AU  - Martin D
FAU - Schweikert, Robert
AU  - Schweikert R
FAU - Wilkoff, Bruce L
AU  - Wilkoff BL
FAU - Grimm, Richard
AU  - Grimm R
FAU - Natale, Andrea
AU  - Natale A
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080917
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
SB  - IM
MH  - Aged
MH  - Cardiac Pacing, Artificial/*methods
MH  - Cardiomyopathies/*diagnosis/*prevention & control
MH  - Female
MH  - Humans
MH  - Male
MH  - Myocardial Ischemia/*diagnosis/*prevention & control
MH  - Myocardial Stunning/*diagnosis/*prevention & control
MH  - Prognosis
MH  - Tissue Survival
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*diagnosis/*prevention & control
EDAT- 2008/09/23 09:00
MHDA- 2009/03/17 09:00
CRDT- 2008/09/23 09:00
PHST- 2008/09/23 09:00 [pubmed]
PHST- 2009/03/17 09:00 [medline]
PHST- 2008/09/23 09:00 [entrez]
AID - JCE1294 [pii]
AID - 10.1111/j.1540-8167.2008.01294.x [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2009 Jan;20(1):50-7. doi: 
      10.1111/j.1540-8167.2008.01294.x. Epub 2008 Sep 17.