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Europace Advance Access originally published online on December 7, 2007
Europace 2008 10(1):63-68; doi:10.1093/europace/eum262
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

CARDIAC RESYNCHRONISATION THERAPY

Mechanical dyssynchrony by 3D echo correlates with acute haemodynamic response to biventricular pacing in heart failure patients

J. van Dijk1,2,*, P. Knaapen1, I.K. Russel3, T. Hendriks1, C.P. Allaart1, C.C. de Cock1 and O. Kamp1,2

1 Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; 2 Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands; 3 Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands

Aims: One-third of dilated cardiomyopathy patients receiving a biventricular pacing-device do not respond to this form of therapy. Therefore, the utility of mechanical dyssynchrony by real-time 3D echocardiography (RT3DE) for predicting systolic response to biventricular pacing, of which maximal rate of pressure rise (dP/dtmax) served as the gold-standard, was evaluated.

Methods and results: Seventeen consecutive heart failure patients (aged 64 ± 10 years, 8 male, 6 ischaemic cardiomyopathy, mean QRS duration 136 ± 32 ms) underwent RT3DE and biventricular pacing. Post-processing software provided data of global left ventricular (LV) function and the systolic dyssynchrony index of 17 LV segments (SDI17, %) for mechanical dyssynchrony. During biventricular pacing, percentual change in dP/dtmax compared to the non-pacing mode, {Delta}dP/dtmax was measured invasively with conductance catheters. LV ejection fraction was 31 ± 10%, SDI17 was 10.2 ± 4.2% and percentual {Delta}dP/dtmax during biventricular pacing was 14.5 ± 12.4. A significant correlation (r = 0.729, P = 0.001) was found between SDI17 and percentual {Delta}dP/dtmax, and between QRS duration and percentual {Delta}dP/dtmax (r = 0.721, P = 0.001).

Conclusion: The present study suggests that mechanical dyssynchrony measured by RT3DE shows a good correlation with invasively determined acute haemodynamic response to biventricular pacing in patients with symptomatic dilated cardiomyopathy. Future studies are needed to further define the clinical utility of RT3DE in identifying patients who are most likely to respond to cardiac resynchronization therapy.

Key Words: Real-time 3D echocardiography, Acute haemodynamic response, Cardiac resynchronization therapy, Heart failure

* Corresponding author. Tel: +31 20 444 2244; fax: +31 20 444 2446.E-mail address: jeroen.vandijk{at}vumc.nl

Manuscript submitted 18 August 2007. Accepted after revision 7 November 2007.


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