Clin Res Cardiol 96:Suppl 2 (2007)

P337 - Predictive Value of Echocardiographic Evaluation of Left Ventricular Asynchronic Contraction for Successful Cardiac Resynchronization Therapy
B. Al-Najjar1, F. von Hoch1, H. Neuser1, J. Brunn1, R. Schamberger1, F. Gietzen1, M. Schneider1, B. Schumacher1, S. Kerber1
1Fachbereich Kardiologie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt a. d. Saale;
Background: Cardiac resynchronization therapy (CRT) is an effective therapy concept for the treatment of advanced heart failure (HF). The patient selection according to ECG criteria results in a relevant non-responder rate (30-35%). The predictive value of different echocardiographic parameters for clinical response and the occurrence of reverse remodelling were evaluated in this study.
Methods: 56 patients (pts) with HF underwent echocardiographic evaluation of asynchronic left ventricular (LV) contraction. The group of pts with asynchronic LV contraction received an ICD with biventricular stimulation (CRT group: 24 pts), the group without determination of asynchronic LV contraction received an ICD without biventricular stimulation (Non-CRT group: 32 pts). After 12 + 6 months the clinical outcome of all pts was evaluated and 54% of pts underwent an echocardiographic re-examination (CRT group 17 pts, Non-CRT group 14 pts).
Results: A left bundle branch block was not a reliable indicator for response to CRT. Echocardiographic evaluation of asynchronic LV contraction and correct placement of the LV lead resulted in a high responder rate (94%), in 86% of the non responders maximal LV contraction delay was different from position of the LV lead. Clinical improvement occured in most pts with reverse remodelling (90%), but did not guarantee reverse remodelling (70%). With CRT a significant reduction of the hospitalisation rate (- 42%) and the mortality rate (- 44%) occurred. PW tissue Doppler measurements of the times between the beginning of the QRS complex and the beginning of the ejection period correlated well with the time measurements until the punctum maximum of the ejection period.
Conclusion: An improvement of patient selection for the cardiac resynchronization therapy can be obtained by using tissue Doppler echocardiography. Placement of the LV lead should be guided by echocardiography and is not necessarily optimal in posterolateral position.