Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing
<p>Abstract</p> <p>Background</p> <p>Chronic right ventricular (RV) apical pacing may lead to left ventricular (LV) dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT) can improve NYHA Class and LV function. A...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2011-12-01
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| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | http://www.cardiovascularultrasound.com/content/9/1/41 |
| _version_ | 1828213506561802240 |
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| author | Morales Maria-Aurora Startari Umberto Rossi Giuseppe Panchetti Luca Rossi Andrea Piacenti Marcello |
| author_facet | Morales Maria-Aurora Startari Umberto Rossi Giuseppe Panchetti Luca Rossi Andrea Piacenti Marcello |
| author_sort | Morales Maria-Aurora |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Chronic right ventricular (RV) apical pacing may lead to left ventricular (LV) dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT) can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients.</p> <p>Methods</p> <p>Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC) in 28 and ischemic cardiomyopathy (IC) in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU).</p> <p>Results</p> <p>Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p <0.001), increased LV end-systolic dimensions (LVESD) (from 48.1 ± 8.6 to 55.2 ± 7.9 mm, p <0.001) and worsened NYHA Class (from 1.9 ± 1.1 to 3.2 ± .6, p < 0.005) were found before CRT, compared to pre RV-pacing. After CRT, 44/62 patients showed a ≥ 1 NYHA Class improvement; >10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p < .0.001). The association between cause of LV dysfunction with >10% decrease in LVESD remained highly significant (p < 0.001) adjusting for pre-CRT QRS duration, NYHA Class, LVEF, LVESD, treatment or RV pacing duration.</p> <p>Conclusions</p> <p>CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.</p> |
| first_indexed | 2024-04-12T14:51:23Z |
| format | Article |
| id | doaj.art-12d4b22b08b14f6098903358b82d64c6 |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-04-12T14:51:23Z |
| publishDate | 2011-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-12d4b22b08b14f6098903358b82d64c62022-12-22T03:28:27ZengBMCCardiovascular Ultrasound1476-71202011-12-01914110.1186/1476-7120-9-41Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacingMorales Maria-AuroraStartari UmbertoRossi GiuseppePanchetti LucaRossi AndreaPiacenti Marcello<p>Abstract</p> <p>Background</p> <p>Chronic right ventricular (RV) apical pacing may lead to left ventricular (LV) dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT) can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients.</p> <p>Methods</p> <p>Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC) in 28 and ischemic cardiomyopathy (IC) in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU).</p> <p>Results</p> <p>Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p <0.001), increased LV end-systolic dimensions (LVESD) (from 48.1 ± 8.6 to 55.2 ± 7.9 mm, p <0.001) and worsened NYHA Class (from 1.9 ± 1.1 to 3.2 ± .6, p < 0.005) were found before CRT, compared to pre RV-pacing. After CRT, 44/62 patients showed a ≥ 1 NYHA Class improvement; >10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p < .0.001). The association between cause of LV dysfunction with >10% decrease in LVESD remained highly significant (p < 0.001) adjusting for pre-CRT QRS duration, NYHA Class, LVEF, LVESD, treatment or RV pacing duration.</p> <p>Conclusions</p> <p>CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.</p>http://www.cardiovascularultrasound.com/content/9/1/41congestive heart failurebiventricular stimulationnon-ischemic cardiomyopathyischemic cardiomyopathy |
| spellingShingle | Morales Maria-Aurora Startari Umberto Rossi Giuseppe Panchetti Luca Rossi Andrea Piacenti Marcello Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing Cardiovascular Ultrasound congestive heart failure biventricular stimulation non-ischemic cardiomyopathy ischemic cardiomyopathy |
| title | Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| title_full | Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| title_fullStr | Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| title_full_unstemmed | Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| title_short | Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| title_sort | reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing |
| topic | congestive heart failure biventricular stimulation non-ischemic cardiomyopathy ischemic cardiomyopathy |
| url | http://www.cardiovascularultrasound.com/content/9/1/41 |
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