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Europace Advance Access originally published online on December 3, 2007
Europace 2008 10(1):69-74; doi:10.1093/europace/eum269
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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

Baseline Doppler parameters are useful predictors of chronic left ventricular reduction in size by cardiac resynchronization therapy

Martin Stockburger*, Suzanne Fateh-Moghadam, Aischa Nitardy, Oezlem Celebi, Alice Krebs, Dirk Habedank and Rainer Dietz

Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany

Aims: The identification of responders to cardiac resynchronization therapy (CRT) in patients with left ventricular (LV) dysfunction and left bundle branch block (LBBB) remains difficult. We aimed to define the predictive value of conventional Doppler parameters.

Methods and results: In 73 patients (65 ± 9 years, 51 male, 36 ischaemic, 37 non-ischaemic cardiomyopathy, QRS 167 ± 31 ms, LVEF 23 ± 6%) with LBBB, a CRT device was implanted. LV pre-ejection interval (PEI), interventricular mechanical delay (IVMD), LV filling time (FT), and myocardial performance index (MPI) were assessed at baseline and on optimized CRT. Left ventricular end-diastolic diameter (EDD) was obtained at baseline and after 10.6 ± 6.7 months. end-diastolic diameter diminished from 66.3 ± 8.1 to 59.9 ± 9.6 mm (P < 0.001). Initial LVPEI (r = 0.41, P < 0.001), baseline IVMD (r = 0.34, P = 0.003), acute LVPEI shortening (r = 0.33, P = 0.006), and baseline LVEDD (r = 0.32, P = 0.007) correlated with LVEDD reduction. An LVPEI ≥140 ms had a 82% accuracy to predict long-term LVEDD reduction (sensitivity 86%, specificity 67%, positive and negative predictive values 91 and 56%, respectively). Multivariate analysis solely revealed baseline LVPEI as predictor of LVEDD reduction. FT and MPI correlated only with their respective improvements.

Conclusion: Left ventricular pre-ejection interval and IVMD predict favourable LV remodelling on CRT. The additional application of tissue Doppler parameters may further increase specificity and negative predictive value.

Key Words: Cardiac resynchronization therapy, Doppler echocardiography, Left ventricular remodelling, Predictors of response

* Corresponding author. Tel.: +49 30 450653635; fax: +49 30 450553961. E-mail address: martin.stockburger{at}charite.de

Manuscript submitted 5 September 2007. Accepted after revision 7 November 2007.


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