Abnormal diastolic function underlies the different beneficial effects of cardiac resynchronization therapy on ischemic and non-ischemic cardiomyopathy

Abstract

OBJECTIVES:To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes.METHODS:The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters.RESULTS:The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy.CONCLUSIONS:This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.

Correlation between Myocardial Velocity Measured using Tissue Doppler Imaging in the Left Ventricular Lead-Implanted Segment and Response to Cardiac Resynchronization Therapy

“…In this study, increased LV filling pressure was also a risk factor for nonresponse to CRT. This finding is consistent with Ciampi Q et al 22, which further validates the results of our previous study 23.…”

Etiologic impact on difference on clinical outcomes of patients with heart failure after cardiac resynchronization therapy

“…Twenty-one studies [16–36] involving 12,331 patients (5736 ICM and 6595 NCM) met the inclusion criteria for meta-analysis. Most of these studies were prospective trials in nature, and 6 were retrospective trials.…”

Effect of left ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy

“… 14 , 15 Once it develops, RFP persists even with optimal medical treatment (pharmacologic), implantable devices (cardiac resynchronization therapy), and surgery that may achieve initial recovery of LV systolic function. 7 , 9 , 10 , 11 , 12 , 13 In patients with ICM and baseline RFP a higher in-hospital mortality has been demonstrated after SVR compared with patients with a non-restrictive filling pattern. 9 , 10 , 11 , 12 , 13 Fantini et al[23] have shown that in those ICM patientswith RFP and preserved relative wall thickness (RWT) reflecting eccentric LV remodelling, the RFP reverted following surgical ventricular restoration (SVR) and these patients fared better than those with reduced RWT and RFP prior to SVR.…”