Intraventricular conduction delay: a prognostic marker in chronic heart failure

Shamim, Waqar; Francis, Dárrel P.; Yousufuddin, Mohammed; Varney, Susan; Pieopli, Masimo F.; Anker, Stefan D.; Coats, Andrew J.S.

doi:10.1016/s0167-5273(99)00077-7

Cited by 349 publications

(201 citation statements)

References 30 publications

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“…The parameters were significantly lower in patients with severe DCM and LBBB than in patients with mild to moderate DCM without LBBB. The ratio of MVO 2 and MBF was not different between LBBB and non-LBBB patients (0.159F0.019 and 0.159F0.020, respectively; not significant).…”

Section: Resultsmentioning

confidence: 81%

“…Although several studies characterized global MVO 2 and MBF in cardiomyopathy with PET, they failed to discriminate between LBBB and non-LBBB patients [17][18][19][20][21]. Recent studies that focused on regional aspects of LBBB on a semiquantitative or quantitative basis mostly of the septal and the lateral walls included only a small number of patients [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, regional wall stress becomes highest in the lateral segments. Consequently, the lateral wall has been shown to exhibit the highest MVO 2 and also the highest MBF because both parameters are closely linked [37,38]. MVO 2 and MBF of the earlier activated walls are lower due to a lower wall stress during their contraction.…”

Section: Regional Mvo 2 and Mbf In Dcm Patients With And Without Lbbbmentioning

confidence: 99%

“…Furthermore, the magnitude of the intraventricular conduction delay associated with LBBB is one of the most powerful prognostic predictors [2]. The consequences of a LBBB on myocardial contraction and motion have been investigated by echocardiography and recently by the sophisticated tissue Doppler imaging.…”

Section: Introductionmentioning

confidence: 99%

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Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block

Lindner

Vogt

Baller

et al. 2005

European Journal of Heart Failure

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Objective: In patients with dilated cardiomyopathy (DCM), left bundle branch block (LBBB) is a common finding. The characteristic feature is an asynchronous septal wall motion and most frequently a delay of the lateral and/or posterior wall segments. With the onset of cardiac resynchronization therapy, there is a focus on the specific pathophysiology of a LBBB. However, quantitative data on regional myocardial oxygen consumption (MVO 2 ) and blood flow (MBF) are missing. Methods: We studied 31 patients with severe DCM and LBBB (ejection fraction 22.1F7.1%) and 14 patients with mild to moderate DCM without LBBB (ejection fraction 46.7F7.9%). Global and regional MVO 2 as well as MBF were determined from a dynamic 11 C-acetate positron emission tomography (PET) study. Results: Global MVO 2 and MBF were lower in the DCM group with LBBB than in the control group ( Pb0.05). Regionally, the LBBB group revealed a higher ( Pb0.05) MVO 2 and MBF in the lateral wall than in the other walls. The control group did not show significant differences between the myocardial walls and demonstrated a smaller variability of the parameters. Conclusion: DCM patients with LBBB exhibit a more heterogeneous distribution of MVO 2 and MBF among the myocardial walls than DCM patients without LBBB. Due to the LBBB associated electromechanical alterations, the highest regional values of MVO 2 and MBF are found in the lateral wall.

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Section: Resultsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Regional Mvo 2 and Mbf In Dcm Patients With And Without Lbbbmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block

Lindner

Vogt

Baller

et al. 2005

European Journal of Heart Failure

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“…In a study with more than 3,500 patients, Shenkman et al 27 pointed to a gradual increase in the prevalence of systolic dysfunction of the left ventricle with the width of the QRS complex more than 120 ms. Patients with heart failure and extended QRS complex have higher mortality and also higher incidence of sudden death as opposed to patients with narrow QRS complex 28 . Nevertheless, a careful analysis in some studies has shown that 20-30% of patients do not benefit from CRT despite the presence of extended QRS complex.…”

Section: Further Question Related To Cardiac Resynchronization Treatmmentioning

confidence: 98%

Does the Resynchronization Therapy Lead to Reduction of Symptoms and to Improvement of Left Ventricular Functions in Patients With Chronic Heart Failure?

Ozábalová¹,

Novák²,

Krejčí³

et al. 2010

BIOMED PAP

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Aim.To evaluate the therapeutic effect of resynchronization in patients with chronic heart failure who are symptomatic despite adequate pharmacological medication.Sample and methodology. 118 patients with chronic heart failure, mostly dilated cardiomyopathy and ischaemic heart disease, with depressed systolic function, decreased left ventricular ejection fraction (LVEF) and left bundle branch block wide QRS complex, underwent implantation of the biventricular system between the years 2000-2006. We assessed changes in the NYHA functional class, hemodynamic parameters acquired during right heart catheterization, the maximum oxygen consumption during stress spiroergometric examination, as well as echocardiographic parameters.Results. A statistically significant improvement was found in the NYHA functional class (from 2.8 ± 0.4 to 2.3 ± 0.5 after 3m, p < 0,001 and to 2.5 ± 0.6 after 12m, p < 0,01 respectively), as well as an increase in the maximum oxygen consumption during spiroergometric examination (VO2 max from 14.1 ± 3.1ml/kg/min to 15.3 ± 3.1 ml/kg/ min, p < 0,001 and to 15.3 ± 2.5 ml/kg/min, p = NS respectively). In regard to hemodynamic parameters, there were increases in cardiac output and cardiac index after three months. After 12 months the change was not statistically significant (CO from 3.9 ± 1 l/min to 4.2 ± 0.9 l/min, p < 0,05, and to 4.1 ± 0.9 l/min, p = NS, CI from 2 ± 0.5l/kg/min to 2.2 ± 0.4l/kg/min, p < 0,05, and to 2.1 ± 0.4 l/kg/min, p = NS). Mean pulmonary artery pressure, as well as pulmonary capillary wedge pressure was reduced after 3, as well as after 12 months to a statistically significant degree (MPA from 29.1 ± 11.5 mm Hg to 23.9 ± 10.3 mm Hg, p< 0,001, and to 24.9 ± 11.8 mm Hg, p < 0,01 respectively, and PCWP from 19.9 ± 9.5 mm Hg to 15.2 ± 9.2 mm Hg, p < 0,01, and to 15.6 ± 9 mm Hg, p < 0,01 respectively). In regard to echocardiographic parameters, there was an increase in LVEF, a reduction in the end-diastolic diameter of the left ventricle, as well as a statistically significant reduction in severity of mitral regurgitation after 3, as well as 12 months (LVEF from 20.5 ± 5.3%, to 23 ± 6.5%, p < 0,001, and to 24.5 ± 8%, p < 0,001, LVEDD from 69 ± 9 mm to 68 ± 9 mm, p < 0.01 and to 65 ± 12 mm, p< 0.01 respectively, mitral regurgitation from 2.2 ± 0.8 to 1.9 ± 0.8, p< 0.001, and to 2 ± 0.8, p < 0.001.Conclusions. In patients with chronic heart failure, resynchronization therapy leads to reduced symptoms, reduction in dyspnea and to improvements in cardiac performance due to increase in the systolic function of the left ventricle and hemodynamic changes.

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Impact of QRS Duration on Clinical Event Reduction With Cardiac Resynchronization Therapy

Sipahi¹

2011

Arch Intern Med

265

119

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Intraventricular conduction delay: a prognostic marker in chronic heart failure

Cited by 349 publications

References 30 publications

Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block

Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block

Does the Resynchronization Therapy Lead to Reduction of Symptoms and to Improvement of Left Ventricular Functions in Patients With Chronic Heart Failure?

Impact of QRS Duration on Clinical Event Reduction With Cardiac Resynchronization Therapy

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