Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

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• 作者：Federica DeVecchi ; Emanuela Facchini ; Anna Degiovanni ; Chiara Sartori ; Chiara Cavallino ; Matteo Santagostino ; Virginia Di Ruocco ; Andrea Magnani ; Eraldo Occhetta ; Paolo Nicola Marino ; ^{paolo.marino@maggioreosp.novara.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CRT ; biventricular stimulation ; DYS ; dyssynchrony ; Ea ; arterial elastance ; EDV ; end-diastolic volume ; Ees ; ventricular elastance ; EF ; ejection fraction ; FFR ; force&ndash ; frequency relation ; HR ; hazard ratio ; LV ; left ventricle ; MR ; mitral regurgitation ; r2 ; adjusted r squared ; TUS ; temporal uniformity of strain
• 刊名：IJC Heart & Vasculature
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：11
• 期：Complete
• 页码：66-73
• 全文大小：740 K

文摘

It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation.

Methods

In 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline.

Results

There was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization.

Conclusions

Acute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.