Abstract
OBJECTIVES:To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes.METHODS:The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters.RESULTS:The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy.CONCLUSIONS:This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.
Highlights
Cardiac resynchronization therapy (CRT) can improve symptoms, increase quality of life, reduce the risk of hospital readmission, and decrease the mortality of chronic heart failure patients [1]
This study showed that [1] the improvement of left ventricular systolic function and remodeling was reduced in ischemic cardiomyopathy patients compared with non-ischemic cardiomyopathy patients; [2] compared with non-ischemic cardiomyopathy patients, ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction; and [3] severe diastolic dysfunction was an independent factor influencing the CRT response
This study showed that the ischemic cardiomyopathy (ICM) group had lower CRT response rates six months after implantation; improvements in left ventricular ejection fraction (LVEF) and LVOT-VTI, which reflect left ventricular (LV) function, and improvements in LVESV, which reflect remodeling, were smaller in the ICM group than in the non-ischemic cardiomyopathy (NICM) group
Summary
Cardiac resynchronization therapy (CRT) can improve symptoms, increase quality of life, reduce the risk of hospital readmission, and decrease the mortality of chronic heart failure patients [1]. The beneficial effects of CRT are smaller in patients with ischemic cardiomyopathy (ICM) than in patients with non-ischemic cardiomyopathy (NICM); ICM is a predictive factor for CRT non-response [3,4]. Given this difference in the beneficial effects of CRT for different patients, prior studies have examined quantity of viable myocardium, myocardial scar burden, degree of scar transmurality, scar location, and left ventricular (LV) pacing to assess the potential relevance of these factors [5,6,7]. We hypothesized that ICM patients who meet CRT indications exhibit more serious diastolic dysfunction than NICM patients, which may be a reason for the differing beneficial effects of CRT
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