The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients

Background: The relationship between optimization according to left ventricular (LV) dp/dt, changes in LV performance, and prognosis of heart failure patients who undergo cardiac resynchronization therapy (CRT) remains unclear. Methods: We studied 27 consecutive patients who underwent CRT implantati...

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Main Authors: Tomoyuki Kabutoya, MD, Takeshi Mitsuhashi, MD, Tomonori Watanabe, MD, Rieko Nakagami, MD, Yoshihito Hata, MD, Kazuyuki Shimada, MD, Kazuomi Kario, MD
Format: Article
Language:English
Published: Wiley 2011-01-01
Series:Journal of Arrhythmia
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S1880427611800463
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author Tomoyuki Kabutoya, MD
Takeshi Mitsuhashi, MD
Tomonori Watanabe, MD
Rieko Nakagami, MD
Yoshihito Hata, MD
Kazuyuki Shimada, MD
Kazuomi Kario, MD
author_facet Tomoyuki Kabutoya, MD
Takeshi Mitsuhashi, MD
Tomonori Watanabe, MD
Rieko Nakagami, MD
Yoshihito Hata, MD
Kazuyuki Shimada, MD
Kazuomi Kario, MD
author_sort Tomoyuki Kabutoya, MD
collection DOAJ
description Background: The relationship between optimization according to left ventricular (LV) dp/dt, changes in LV performance, and prognosis of heart failure patients who undergo cardiac resynchronization therapy (CRT) remains unclear. Methods: We studied 27 consecutive patients who underwent CRT implantation (18 males, 9 females; age, 67.3 ± 8.3 years). We measured LV dp/dt to determine the timing of LV-right ventricular (RV) sequential pacing. Echocardiographic examination was performed before and after the CRT procedure to assess LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Primary endpoints were all-cause death and cardiac hospitalization. Results: An increase in LV dp/dt during CRT was significantly associated with an increase in LVEF (r = 0.47, p = 0.018), but was not associated with a decrease in LVEDD. The mean follow-up period was 14 ± 13 months, and six endpoints were observed. In the control group, no subjects encountered any of the endpoints, and they had higher LVEDD reductions (5.7 ± 8.4 vs. ± 2.5 ± 4.6 mm; p = 0.034) than those in the event group. Cox regression analysis revealed that a reduction in LVEDD was a significant predictor of event-free survival. Conclusions: The measurement of LV dp/dt might be useful for the optimization of CRT. Reductions in LVEDD are necessary to achieve improvements in the long-term prognosis of CRT patients.
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spelling doaj.art-b8797b3ac0b34496b3876a394721d9402022-12-21T19:17:58ZengWileyJournal of Arrhythmia1880-42762011-01-0127320821310.1016/S1880-4276(11)80046-3The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure PatientsTomoyuki Kabutoya, MD0Takeshi Mitsuhashi, MD1Tomonori Watanabe, MD2Rieko Nakagami, MD3Yoshihito Hata, MD4Kazuyuki Shimada, MD5Kazuomi Kario, MD6Division of Cardiovascular Medicine, Shimotsuga General Hospital, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, JapanBackground: The relationship between optimization according to left ventricular (LV) dp/dt, changes in LV performance, and prognosis of heart failure patients who undergo cardiac resynchronization therapy (CRT) remains unclear. Methods: We studied 27 consecutive patients who underwent CRT implantation (18 males, 9 females; age, 67.3 ± 8.3 years). We measured LV dp/dt to determine the timing of LV-right ventricular (RV) sequential pacing. Echocardiographic examination was performed before and after the CRT procedure to assess LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Primary endpoints were all-cause death and cardiac hospitalization. Results: An increase in LV dp/dt during CRT was significantly associated with an increase in LVEF (r = 0.47, p = 0.018), but was not associated with a decrease in LVEDD. The mean follow-up period was 14 ± 13 months, and six endpoints were observed. In the control group, no subjects encountered any of the endpoints, and they had higher LVEDD reductions (5.7 ± 8.4 vs. ± 2.5 ± 4.6 mm; p = 0.034) than those in the event group. Cox regression analysis revealed that a reduction in LVEDD was a significant predictor of event-free survival. Conclusions: The measurement of LV dp/dt might be useful for the optimization of CRT. Reductions in LVEDD are necessary to achieve improvements in the long-term prognosis of CRT patients.http://www.sciencedirect.com/science/article/pii/S1880427611800463Cardiac resynchronization therapyPacemakerHeart failure
spellingShingle Tomoyuki Kabutoya, MD
Takeshi Mitsuhashi, MD
Tomonori Watanabe, MD
Rieko Nakagami, MD
Yoshihito Hata, MD
Kazuyuki Shimada, MD
Kazuomi Kario, MD
The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
Journal of Arrhythmia
Cardiac resynchronization therapy
Pacemaker
Heart failure
title The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
title_full The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
title_fullStr The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
title_full_unstemmed The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
title_short The Relationship between Optimization for Cardiac Resynchronization Therapy by Measurement of dp/dt and the Middle-to-long-term Prognosis of Heart Failure Patients
title_sort relationship between optimization for cardiac resynchronization therapy by measurement of dp dt and the middle to long term prognosis of heart failure patients
topic Cardiac resynchronization therapy
Pacemaker
Heart failure
url http://www.sciencedirect.com/science/article/pii/S1880427611800463
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