Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapy—results from the LOw dose DObutamine Stress-Echo Test in Cardiac Resynchronization Therapy (LODO-CRT) Trial

Muto, Carmine; Gasparini, Maurizio; Neja, Carlo Peraldo; Iacopino, Saverio; Davinelli, Mario; Zanon, Francesco; Dicandia, Cosimo; Distefano, Giuseppe; Donati, Roberto; Calvi, Valéria; Denaro, Alessandra; Tuccillo, Bernardino

doi:10.1016/j.hrthm.2010.07.036

Cited by 26 publications

(15 citation statements)

References 33 publications

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“…In addition to this different response to CRT, Klimusina et al found that non-responders tend to have larger ventricular diameters and lower baseline global radial peak strain as well as segmental radial peak strain values. These findings underline the importance of myocardial substrate for successful CRT and are in accordance with previous studies that showed the influence of myocardial contractile reserve on response to CRT [22]. Moreover, prevalence of mechanical dyssynchrony was similar in both responders and non-responders, thus reducing the value of this parameter for predicting the response to CRT.…”

Section: Introductionsupporting

confidence: 91%

Past, present, and future of CRT

Auricchio

Regoli

2010

Heart Fail Rev

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Cardiac resynchronization therapy is a key non-pharmacological treatment strategy for drug-refractory moderate-to-severe symptomatic heart failure in the presence of compromised left ventricular function and ventricular conduction delay. Because not all patients with conventional criteria benefit from CRT, continuous efforts have been directed toward improving patient selection; in particular, emerging echocardiographic criteria such as regional and global myocardial strains are being investigated to better predict CRT response. In the meantime, growing evidence from large randomized controlled trials (RCTs, REVERSE, and MADIT-CRT) has demonstrated that even mildly symptomatic patients may benefit from CRT. The role of CRT in heart failure patients with narrow QRS, however, remains to be defined in the scheme of larger RCTs (such as EchoCRT) as the ones carried out thus far (RethinQ and ESTEEM-CRT). Important experimental data derived from animal heart failure models are gradually elucidating the complex pathophysiological basis of cardiac dyssynchrony, which involves diffuse alterations from genome to structure. At the same time, technological breakthroughs, such as wireless endocardial cardiac pacing, will render the prospect of delivering CRT more precisely and more effectively, a reality in the near future.

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Section: Introductionsupporting

confidence: 91%

Past, present, and future of CRT

Auricchio

Regoli

2010

Heart Fail Rev

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“…Prior to enrollment, approximately 70–80 patients will be screened by means of an echo-dobutamine stress (DSE) test in order to evaluate the presence of left ventricular contractile reserve. Low-dose dobutamine stress echocardiography (LDSE) is a simple, cost-effective, and widely available method of identifying contractile reserve in the LV [18, 19]. The dose of intravenous dobutamine will be increased in 5 μg kg −1 min −1 increments every 5 minutes up to a recommended maximum dose of 20 μg kg −1 min −1 .…”

Section: Methodsmentioning

confidence: 99%

“…The left ventricular ejection fraction (LVEF), measured offline by means of Simpson’s biplane quantitative method, will be determined at each infusion rate (including baseline). An absolute increase of 5 points or higher in LVEF above the baseline will demonstrate the presence of LV contractile reserve and will be considered a positive LDSE test [18]. Only patients who have a positive LDSE test will be enrolled if they meet the inclusion criteria reported in Table 1.…”

Section: Methodsmentioning

confidence: 99%

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Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial

Gasparini

Galimberti

Bragato

et al. 2016

Trials

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BackgroundDespite an intensive search for predictors of the response to cardiac resynchronization therapy (CRT), the QRS duration remains the simplest and most robust predictor of a positive response. QRS duration of ≥ 130 ms is considered to be a prerequisite for CRT; however, some studies have shown that CRT may also be effective in heart failure (HF) patients with a narrow QRS (<130 ms). Since CRT can now be performed by pacing the left ventricle from multiple vectors via a single quadripolar lead, it is possible that multipoint pacing (MPP) might be effective in HF patients with a narrow QRS. This article reports the design of the MPP Narrow QRS trial, a prospective, randomized, multicenter, controlled feasibility study to investigate the efficacy of MPP using two LV pacing vectors in patients with a narrow QRS complex (100–130 ms).MethodsFifty patients with a standard ICD indication will be enrolled and randomized (1:1) to either an MPP group or a Standard ICD group. All patients will undergo a low-dose dobutamine stress echo test and only those with contractile reserve will be included in the study and randomized. The primary endpoint will be the percentage of patients in each group that have reverse remodeling at 12 months, defined as a reduction in left ventricular end-systolic volume (LVESV) of >15% from the baseline.DiscussionThis feasibility study will determine whether MPP improves reverse remodeling, as compared with standard ICD, in HF patients who have a narrow QRS complex (100–130 ms).Trial registrationClinicalTrials.gov, NCT02402816. Registered on 25 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1698-1) contains supplementary material, which is available to authorized users.

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“…1,7,8 There are, however, reasons to believe that there is still room for an assessment of mechanical dyssynchrony. 9 Recent studies have focused less on the estimation of mechanical dyssynchrony and more on the characterization of the myocardial substrate [10][11][12][13][14] to describe the complexity of LV mechanics before and during CRT. The development of speckletracking echocardiography, combining the assessment of LV dyssynchrony and contractility, was a cornerstone in this approach.…”

mentioning

confidence: 99%