Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing

Cardiovascular Ultrasound

Research

Marcello Piacenti¹  Maria-Aurora Morales¹  Giuseppe Rossi¹  Luca Panchetti²  Andrea Rossi²  Umberto Startari² 

[1] via G Moruzzi 1, CNR Clinical Physiology Institute, 56124, Pisa, Italy;via G Moruzzi 1, Fondazione Toscana Gabriele Monasterio, 56124, Pisa, Italy;

关键词: congestive heart failure;    biventricular stimulation;    non-ischemic cardiomyopathy;    ischemic cardiomyopathy;   

DOI  :  10.1186/1476-7120-9-41

 received in 2011-09-28, accepted in 2011-12-16,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundChronic right ventricular (RV) apical pacing may lead to left ventricular (LV) dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT) can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients.MethodsSixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC) in 28 and ischemic cardiomyopathy (IC) in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU).ResultsDecreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p <0.001), increased LV end-systolic dimensions (LVESD) (from 48.1 ± 8.6 to 55.2 ± 7.9 mm, p <0.001) and worsened NYHA Class (from 1.9 ± 1.1 to 3.2 ± .6, p < 0.005) were found before CRT, compared to pre RV-pacing. After CRT, 44/62 patients showed a ≥ 1 NYHA Class improvement; >10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p < .0.001). The association between cause of LV dysfunction with >10% decrease in LVESD remained highly significant (p < 0.001) adjusting for pre-CRT QRS duration, NYHA Class, LVEF, LVESD, treatment or RV pacing duration.ConclusionsCRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.

【 授权许可】

CC BY   
© Morales et al; licensee BioMed Central Ltd. 2011