Left ventricular apical wall motion abnormality is associated with lack of response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy
Por:
Buch, E, Lellouche, N, De Diego, C, Vaseghi, M, Cesario, D, Fujimura, O, Wiener, I, Child, J, Boyle, N and Shivkumar, K
Publicada:
1 oct 2007
Resumen:
BACKGROUND Many patients with appropriate indications fait to respond to cardiac resynchronization therapy (CRT).
OBJECTIVE The purpose of our study was to determine the relationship between CRT response and preimplantation apical wall motion abnormality.
METHODS We analyzed data from 83 patients with ischemic cardiomyopathy who underwent CRT. All patients had New York Heart Association class III or IV symptoms despite maximal medical therapy, Left ventricular ejection fraction (LVEF) <= 35%, and QRS duration >= 130 ms or <130 ms with Left ventricular dyssynchrony. CRT responders at 6 months were defined as surviving patients with: (1) no hospitalization for heart failure, and (2) improvement of New York Heart Association classification. Patients underwent echocardiography before and 6 months after implantation to assess changes in regional watt motion and LVEF.
RESULTS At baseline, CRT responders (n = 39) and nonresponders (n = 44) had similar LVEF (22.9%+/- 6.9% vs 23.1%+/- 8.3%), QRS duration (159 43 ms vs 159 36 ms), and medical treatment. CRT nonresponders had a higher prevalence of preimplantation apical wall motion abnormality (68% vs 33%, P =.003). Patients with baseline apical watt motion abnormalities (n = 43) were less likely than others (n = 40) to show improvement in watt motion at 6 months (30% vs 81%, P <.001) or clinical response to CRT (31% vs 64%, P =.003).
CONCLUSION The presence of a preimplantation apical watt motion abnormality was associated with a lower rate of CRT response in patients with ischemic cardiomyopathy.
Filiaciones:
Univ Calif Los Angeles, Cardiac Arrhythmia Ctr, David Geffen Sch Med, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA.
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