Pacing and Heart Failure Echocardiographic Quantification of Left Ventricular Asynchrony Predicts an Acute Hemodynamic Benefit of Cardiac Resynchronization Therapy

OBJECTIVES We sought to determine whether radial left ventricular (LV) asynchrony in patients with heart failure predicts systolic function improvement with cardiac resynchronization therapy (CRT). BACKGROUND We quantified LV wall motion by echocardiography to correlate the effects of CRT on LV systolic function with wall motion synchrony. METHODS Thirty-four patients underwent echocardiographic phase analysis of LV septal and lateral wall motion and hemodynamic testing before CRT. Phase relationships were measured by the difference between the lateral ( L) and septal ( S) wall motion phase angles: LS L S. The absolute value of LS was used as an order-independent measure of synchrony: LS L S . RESULTS Three phase relationships were identified (mean SD): type 1 (n 4; peak positive LV pressure [dP/dtmax] 692 310 mm Hg/s; LS 5 6°, synchronous wall motion); type 2 (n 17; dP/dtmax 532 148 mm Hg/s; LS 77 33°, delayed lateral wall motion); and type 3 (n 13; dP/dtmax 558 154 mm Hg/s; LS 115 33°, delayed septal wall motion, triphasic). A large LS predicted a larger increase in dP/dtmax with CRT (r 0.74, p 0.001). Sixteen patients were studied during right ventricular (RV), LV and biventricular (BV) pacing. Cardiac resynchronization therapy acutely reduced LS from 104 41° (OFF) to 86 45° (RV; p 0.14 vs. OFF), 71 50° (LV; p 0.001 vs. OFF) and 66 42° (BV; p 0.001 vs. OFF). A reduction in LS predicted an improvement in dP/dtmax in type 2 patients for LV (r 0.87, p 0.005) and BV CRT (r 0.73, p 0.04). CONCLUSIONS Echocardiographic quantification of LV asynchrony identifies patients likely to have improved systolic function with CRT. Improved synchrony is directly related to improved hemodynamic systolic function in type 2 patients. (J Am Coll Cardiol 2002;40:536–45) © 2002 by the American College of Cardiology Foundation

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