TITLE

Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy

AUTHOR(S)
Fung, Jeffrey W. H.; Chan, Joseph Y. S.; Yip, Gabriel W. K.; Chan, Hamish C. K.; Chan, Winnie W. I.; Qing Zhang; Cheuk-Man Yu
PUB. DATE
April 2007
SOURCE
Heart;Apr2007, Vol. 93 Issue 4, p432
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To explore the left ventricular (LV) electrical activation pattern in heart failure (HF) and its implication to cardiac resynchronization therapy (CRT). Design and setting: Observational study at the University Teaching Hospital. Patients: 23 optimally treated patients with HF with New York Heart Association class III, QRS duration >120 ms and LV ejection fraction <35%. Interventions: The LV endocardial activation pattern and total activation time (Tat) was determined by non-contact mapping and the LV mechanical dys-synchrony was determined by standard deviation (Ts-SD) and maximal difference (Ts-diff) of time to peak systolic contraction (Ts) among 12 LV segments using tissue Doppler imaging before receiving CRT. Main outcome measures: Correlation between electrical and mechanical dys-synchrony; volumetric responder to CRT at 3 months; HF hospitalisation or death by Kaplan-Meier analysis. Results: Homogenous (type I, n = 8) and presence of conduction block (type II, n = 15) patterns were identified. Significant correlation between Tat and Ts-SD/Ts-diff was noted only in type II (r=0.73/0.56, p=0.002/0.03). Ts-SD and Ts-diff in type II were significantly longer than type I. 12 patients in type II and 2 in type I were CRT responders (p=0.01). After 487 (447) days, patients with type II pattern had significantly lower risk of HF hospitalisation or death than those with type I (log rank χ²=5.25; p = 0.02). Conclusion: Patients with type II LV endocardial activation pattern had a more favourable echocardiographic and clinical response to CRT than those with type I pattern.
ACCESSION #
25570502

 

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