Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy

Maria Cristina Porciani, Sergio Valsecchi, Gabriele Demarchi, Andrea Colella, Antonio Michelucci, Paolo Pieragnoli, Nicola Musilli, Gian Franco Gensini, Luigi Padeletti

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Cardiac resynchronization therapy (CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern (LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT. Methods: 65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP (RFP) was present in 25 patients, whereas 40 patients showed no-RFP. Results: After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio (E / A) increased from 0.8 ± 0.3 to 1.0 ± 0.6 (p = 0.006) and E wave deceleration time (DT) decreased from 234 ± 83 ms to 196 ± 51 ms (p = 0.028). In 13 RFP patients, E / A decreased from 2.2 ± 0.9 to 0.8 ± 0.5 and DT increased from 128 ± 43 ms to 205 ± 52 ms (both p <0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5% (2 / 40) and 15% (2 / 13) respectively. The remaining patients showed persistence of RFP (E / A and DT unchanged), no improvement and a mortality rate of 42% (5 / 12) (p = 0.005, versus no-RFP). Conclusions: CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.

Original languageEnglish
Pages (from-to)322-328
Number of pages7
JournalInternational Journal of Cardiology
Volume112
Issue number3
DOIs
Publication statusPublished - Oct 10 2006

Fingerprint

Cardiac Resynchronization Therapy
Heart Ventricles
Deceleration
Bundle-Branch Block
Mortality
Treatment Failure
Heart Failure

Keywords

  • Diastole
  • Heart failure
  • Pacing
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Porciani, M. C., Valsecchi, S., Demarchi, G., Colella, A., Michelucci, A., Pieragnoli, P., ... Padeletti, L. (2006). Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy. International Journal of Cardiology, 112(3), 322-328. https://doi.org/10.1016/j.ijcard.2005.10.002

Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy. / Porciani, Maria Cristina; Valsecchi, Sergio; Demarchi, Gabriele; Colella, Andrea; Michelucci, Antonio; Pieragnoli, Paolo; Musilli, Nicola; Gensini, Gian Franco; Padeletti, Luigi.

In: International Journal of Cardiology, Vol. 112, No. 3, 10.10.2006, p. 322-328.

Research output: Contribution to journalArticle

Porciani, MC, Valsecchi, S, Demarchi, G, Colella, A, Michelucci, A, Pieragnoli, P, Musilli, N, Gensini, GF & Padeletti, L 2006, 'Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy', International Journal of Cardiology, vol. 112, no. 3, pp. 322-328. https://doi.org/10.1016/j.ijcard.2005.10.002
Porciani, Maria Cristina ; Valsecchi, Sergio ; Demarchi, Gabriele ; Colella, Andrea ; Michelucci, Antonio ; Pieragnoli, Paolo ; Musilli, Nicola ; Gensini, Gian Franco ; Padeletti, Luigi. / Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy. In: International Journal of Cardiology. 2006 ; Vol. 112, No. 3. pp. 322-328.
@article{1bbe4c05b3ef44ccb042dedb0d40f40f,
title = "Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy",
abstract = "Background: Cardiac resynchronization therapy (CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern (LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT. Methods: 65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP (RFP) was present in 25 patients, whereas 40 patients showed no-RFP. Results: After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio (E / A) increased from 0.8 ± 0.3 to 1.0 ± 0.6 (p = 0.006) and E wave deceleration time (DT) decreased from 234 ± 83 ms to 196 ± 51 ms (p = 0.028). In 13 RFP patients, E / A decreased from 2.2 ± 0.9 to 0.8 ± 0.5 and DT increased from 128 ± 43 ms to 205 ± 52 ms (both p <0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5{\%} (2 / 40) and 15{\%} (2 / 13) respectively. The remaining patients showed persistence of RFP (E / A and DT unchanged), no improvement and a mortality rate of 42{\%} (5 / 12) (p = 0.005, versus no-RFP). Conclusions: CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.",
keywords = "Diastole, Heart failure, Pacing, Prognosis",
author = "Porciani, {Maria Cristina} and Sergio Valsecchi and Gabriele Demarchi and Andrea Colella and Antonio Michelucci and Paolo Pieragnoli and Nicola Musilli and Gensini, {Gian Franco} and Luigi Padeletti",
year = "2006",
month = "10",
day = "10",
doi = "10.1016/j.ijcard.2005.10.002",
language = "English",
volume = "112",
pages = "322--328",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - Evolution and prognostic significance of diastolic filling pattern in cardiac resynchronization therapy

AU - Porciani, Maria Cristina

AU - Valsecchi, Sergio

AU - Demarchi, Gabriele

AU - Colella, Andrea

AU - Michelucci, Antonio

AU - Pieragnoli, Paolo

AU - Musilli, Nicola

AU - Gensini, Gian Franco

AU - Padeletti, Luigi

PY - 2006/10/10

Y1 - 2006/10/10

N2 - Background: Cardiac resynchronization therapy (CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern (LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT. Methods: 65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP (RFP) was present in 25 patients, whereas 40 patients showed no-RFP. Results: After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio (E / A) increased from 0.8 ± 0.3 to 1.0 ± 0.6 (p = 0.006) and E wave deceleration time (DT) decreased from 234 ± 83 ms to 196 ± 51 ms (p = 0.028). In 13 RFP patients, E / A decreased from 2.2 ± 0.9 to 0.8 ± 0.5 and DT increased from 128 ± 43 ms to 205 ± 52 ms (both p <0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5% (2 / 40) and 15% (2 / 13) respectively. The remaining patients showed persistence of RFP (E / A and DT unchanged), no improvement and a mortality rate of 42% (5 / 12) (p = 0.005, versus no-RFP). Conclusions: CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.

AB - Background: Cardiac resynchronization therapy (CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern (LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT. Methods: 65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP (RFP) was present in 25 patients, whereas 40 patients showed no-RFP. Results: After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio (E / A) increased from 0.8 ± 0.3 to 1.0 ± 0.6 (p = 0.006) and E wave deceleration time (DT) decreased from 234 ± 83 ms to 196 ± 51 ms (p = 0.028). In 13 RFP patients, E / A decreased from 2.2 ± 0.9 to 0.8 ± 0.5 and DT increased from 128 ± 43 ms to 205 ± 52 ms (both p <0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5% (2 / 40) and 15% (2 / 13) respectively. The remaining patients showed persistence of RFP (E / A and DT unchanged), no improvement and a mortality rate of 42% (5 / 12) (p = 0.005, versus no-RFP). Conclusions: CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.

KW - Diastole

KW - Heart failure

KW - Pacing

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=33748789843&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748789843&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2005.10.002

DO - 10.1016/j.ijcard.2005.10.002

M3 - Article

C2 - 16318886

AN - SCOPUS:33748789843

VL - 112

SP - 322

EP - 328

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 3

ER -