QRS pattern and improvement in right and left ventricular function after cardiac resynchronization therapy: a radionuclide study

BMC Cardiovascular Disorders

Research Article

Huberdine Foulkes¹  Eric Fleury¹  Henri Sunthorn¹  Haran Burri¹  Gilberto Gavaruzzi²  Cinzia Valzania³  Cristian Martignani³  Francesco Fallani³  Mauro Biffi³  Igor Diemberger³  Giuseppe Boriani³  Giulia Domenichini⁴ 

[1] Cardiology Service, University Hospital of Geneva, Geneva, Switzerland;Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy;Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy;Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy;Cardiology Service, University Hospital of Geneva, Geneva, Switzerland;

关键词: Cardiac resynchronization therapy;    Left ventricular ejection fraction;    Right ventricular ejection fraction;    Dyssynchrony;    Nuclear angiography;    QRS morphology;   

DOI  :  10.1186/1471-2261-12-27

 received in 2011-10-20, accepted in 2012-04-11,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPredicting response to cardiac resynchronization therapy (CRT) remains a challenge. We evaluated the role of baseline QRS pattern to predict response in terms of improvement in biventricular ejection fraction (EF).MethodsConsecutive patients (pts) undergoing CRT implantation underwent radionuclide angiography at baseline and at mid-term follow-up. The relationship between baseline QRS pattern and mechanical dyssynchrony using phase analysis was evaluated. Changes in left and right ventricular EF (LVEF and RVEF) were analyzed with regard to baseline QRS pattern.ResultsWe enrolled 56 pts, 32 with left bundle branch block (LBBB), 4 with right bundle branch block (RBBB) and 20 with non-specific intraventricular conduction disturbance (IVCD). A total of 48 pts completed follow-up. LBBB pts had significantly greater improvement in LVEF compared to RBBB or non-specific IVCD pts (+9.6 ± 10.9% vs. +2.6 ± 7.6%, p = 0.003). Response (defined as ≥ 5% increase in LVEF) was observed in 68% of LBBB vs. 24% of non-specific IVCD pts (p = 0.006). None of the RBBB pts were responders. RVEF was significantly improved in LBBB (+5.0 ± 9.0%, p = 0.007), but not in non-specific IVCD and RBBB pts (+0.4 ± 5.8%, p = 0.76). At multivariate analysis, LBBB was the only predictor of LVEF response (OR, 7.45; 95% CI 1.80-30.94; p = 0.006), but not QRS duration or extent of mechanical dyssynchrony.ConclusionsPresence of a LBBB is a marker of a positive response to CRT in terms of biventricular improvement. Pts with non-LBBB pattern show significantly less benefit from CRT than those with LBBB.

【 授权许可】

Unknown   
© Domenichini et al; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.