The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy.
Eur J Echocardiogr
; 9(4): 483-8, 2008 Jul.
Article
em En
| MEDLINE
| ID: mdl-17826355
ABSTRACT
AIM:
The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. METHODS ANDRESULTS:
Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as >/=10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR 19.62; 95% CI 2.5-151.9; P = 0.004) independently predicted LV reverse remodeling.CONCLUSION:
In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.
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Bases de dados:
MEDLINE
Assunto principal:
Estimulação Cardíaca Artificial
/
Disfunção Ventricular Esquerda
/
Remodelação Ventricular
/
Infarto do Miocárdio
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur J Echocardiogr
Assunto da revista:
CARDIOLOGIA
/
DIAGNOSTICO POR IMAGEM
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Holanda