Presence of left ventricular contractile reserve, evaluated by means of dobutamine stress-echo test, is able to predict response to cardiac resynchronization therapy

Abstract

Contractile reserve was a strong predictive factor of response to CRT in the studied population.

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

“…[11][12][13]25 However, a prospective evaluation of this phenomenon in a large sample of subjects with indications for CRT was still missing. The LODO-CRT trial is the first multicenter clinical trial demonstrating, in a large number of candidates for CRT, a strong association between the presence of LVCR at baseline and a positive response to therapy.…”

“…In particular, almost all singlecenter experiences had reported that a DSE test is able to detect nonresponsiveness to CRT with high specificity. [11][12][13] There may be several explanations for this discrepancy. First of all, the predefined cutoff for the DSE test used in the LODO-CRT trial is different from those used by other investigators.…”

“…On the other hand, a few preliminary single-center studies highlighted that the left ventricular contractile reserve (LVCR) is independently associated with a positive response to CRT. [11][12][13] Moreover, it is demonstrated that the low-dose dobutamine stress-echo (DSE) test detects the presence of LVCR in HF patients of any etiology. 14 -16 LOw dose DObutamine stress-echo in CRT (LODO-CRT) 17 is an observational study designed to evaluate the predictive role of the LVCR, which is estimated by means of a low-dose DSE test, in the assessment of response to CRT.…”

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

“…Studies have reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after biventricular stimulation (CRT) [1], [2]. Controversy, however, exists about the capacity of the inotropic challenge to predict a long-term clinical response.…”

Kardiale Resynchronisationstherapie mit «Multisite Linksventrikulärer Stimulation»

“…Als Gründe für sog. «NonResponder» werden neben zahlreichen Patienten-assoziierten Faktoren unter anderem eine suboptimale Position der linksventrikulären Elektrode postuliert [5,6]. Die Suche nach Optimierungsmöglichkeiten der konventionellen CRT haben verschiedene Forschergruppen dazu gebracht, den Effekt der linksventrikulären Stimulation von mehr als einer Lokalisation zu untersuchen.…”