Guiding Left Ventricular Lead Positioning and Refining Ability to Predict Response and Nonresponse to Cardiac Resynchronization Therapy Using dP/dtmax

Bozkurt, Biykem; Ramasubbu, Kumudha

doi:10.1016/j.jacc.2011.06.014

Cited by 2 publications

(4 citation statements)

References 19 publications

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“…They comment that our results fit with physiological concepts regarding cardiac resynchronization therapy but are not supported by their findings that baseline rather than change in (the maximum rate of LV pressure rise LVdP/dt max ) predicted survival (2).…”

Section: Replycontrasting

confidence: 84%

“…We note the findings of Bogaard et al (2) and would like to highlight several important differences between studies. Their patient population was different and predominantly ischemic: 56% versus 36% in our study.…”

Section: Replymentioning

confidence: 68%

“…We found a moderate correlation between percentage rise in LVdP/dt max and extent of remodeling (r ϭ 0.6) but no relationship between baseline LVdP/dt max and remodeling. We used baseline atrial pacing to account for heart rate changes causing a rise in dP/dt max as described previously and our baseline dP/dt max was comparable to the reported study (2).…”

Section: Replymentioning

confidence: 99%

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Is Acute Hemodynamic Response a Predictor of Long-Term Outcome in Cardiac Resynchronization Therapy?

Prinzen¹,

Houthuizen²,

Bogaard³

et al. 2012

Journal of the American College of Cardiology

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Is Acute Hemodynamic Response a Predictor of Long-Term Outcome in Cardiac Resynchronization Therapy?In a recent issue of the Journal, Duckett et al.(1) published a study indicating that the acute hemodynamic response ([AHR], assessed by LVdP/dt max , the maximum rate of rise of left ventricular pressure) predicts reverse remodeling ([RR], which is the decrease in left ventricular end-systolic volume) in recipients of cardiac resynchronization therapy (CRT). At first glance, these results seem long-awaited and fit with physiological ideas about the action of CRT. In an editorial comment, Bozkurt and Ramasubbu (2) mention that "whether a nonresponse to early surrogate testing will identify the chronic nonresponder to CRT, with respect to hard clinical endpoints, remains to be answered." Recently, we investigated the relation between LVdP/dt max and survival in the majority of CRT patients treated in 2 centers over a 5-year period (n ϭ 285) (3). Absolute LVdP/dt max at baseline predicted 1-year mortality (hazard ratio: 0.79), but the change in LVdP/dt max upon CRT had no relation to outcome. As frequent users of LVdP/ dt max for CRT optimization, we were initially surprised and disappointed by these findings. However, the data are strong and consistent with a recent Japanese study (4). Therefore, we think that there is stronger evidence against than in favor of a relation between AHR and long-term outcome. The apparently contradictory findings by Duckett et al. (1) may be (in part) explained by several limitations of their study: 1) its sample size was small (n ϭ 32), explaining why adjusting the cutoff value for percentage of change in LVdP/dt max from 10% to 11.1% (a small difference, considering the ϳ8% baseline drift in LVdP/dt max ), increased specificity from 64% to 86%; 2) switching from natural sinus rhythm to atrial pacing caused an unusually large (ϳ11%) increase in LVdP/dt max; 3) it is not mentioned whether these patients were a selected subgroup or consecutive patients; 4) the relation between AHR and RR was only evaluated by dichotomously separating responders and nonresponders, without showing a scatter plot or linear regression; and 5) it was not reported whether absolute baseline LVdP/dt max related to RR. Because baseline LVdP/dt max strongly determines percentage of change in LVdP/dtmax, it may seem that the percentage of change in LVdP/dt max relates to RR, although it is actually the absolute baseline value. Summarizing, we think that there are some questions regarding the reported relation between AHR and RR (1) and that there is even less evidence to support using AHR to predict long-term outcome in CRT. REFERENCES 1. Duckett SG, Ginks M, Shetty AK, et al. Invasive acute hemodynamic response to guide left ventricular lead implantation predicts chronic remodeling in patients undergoing cardiac resynchronization therapy. J Am Coll Cardiol. 2011;58:1128 -36. 2. Bozkurt B, Ramasubbu K. Guiding left ventricular lead positioning and refining ability to predict response and nonresponse to cardiac res...

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Section: Replycontrasting

confidence: 84%

Section: Replymentioning

confidence: 68%

Section: Replymentioning

confidence: 99%

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Is Acute Hemodynamic Response a Predictor of Long-Term Outcome in Cardiac Resynchronization Therapy?

Prinzen¹,

Houthuizen²,

Bogaard³

et al. 2012

Journal of the American College of Cardiology

View full text Add to dashboard Cite

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“…It is possible that the FFR-induced increment in inotropy in our study (+ 3 ± 0.9% points absolute increment in ejection fraction between CRT vs. AAI–VVI pacing modes at maximum heart rate achieved [data not shown]), which was less than what we obtain with dobutamine infusion (> 5 points absolute increment in the LODO-CRT trial [3]), was inadequate for evoking any obvious beneficial effect during the follow-up. In any case, it remains unclear whether a response to early surrogate testing would identify the chronic responders to CRT with respect to hard clinical end points [25]. This reasoning is in line with another report that described how the acute improvement in dP/dt max was not correlated to the clinical outcome, although dP/dt max , measured at baseline and during CRT, was a predictor of 1-year survival free from mortality, heart transplantation, or LV assist device implantation [26].…”

Section: Discussionmentioning

confidence: 99%

Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

Vecchi

Facchini

Degiovanni

et al. 2016

IJC Heart & Vasculature

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BackgroundIt has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation.MethodsIn 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline.ResultsThere was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization.ConclusionsAcute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.

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Guiding Left Ventricular Lead Positioning and Refining Ability to Predict Response and Nonresponse to Cardiac Resynchronization Therapy Using dP/dtmax

Cited by 2 publications

References 19 publications

Is Acute Hemodynamic Response a Predictor of Long-Term Outcome in Cardiac Resynchronization Therapy?

Is Acute Hemodynamic Response a Predictor of Long-Term Outcome in Cardiac Resynchronization Therapy?

Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

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