Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure

Abstract

Background Patients with heart failure frequently exhibit intraventricular conduction delays, which contribute to asynchronous contraction patterns and impaired hemodynamic performance. Cardiac resynchronization therapy (CRT) with biventricular (BV) and left ventricular (LV) pacing has been shown to improve both hemodynamic and clinical performance. This study investigated the effects of CRT on LV Doppler indices in these patients. Methods and Results Thirty-two patients with advanced heart failure (New York Heart Association class ≥III, QRS >120 milliseconds, PR interval >150 milliseconds) were studied 4 weeks after implantation of a CRT system. Doppler echocardiography was conducted in 3 separate CRT modes, right ventricular, LV, and BV stimulation at 3 different atrioventricular delays. CRT resulted in significant improvement of Doppler parameters such as filling time (FT, 313 ± 111 milliseconds at baseline → 363 ± 154 milliseconds [BV], P <.05), aortic velocity time integral (AOVTI 23.2 ± 7.4 cm at baseline → 26.8 ± 8.8 cm [LV], P <.05), and the myocardial performance index (MPI, 1.21 ± 0.51 at baseline → 0.85 ± 0.34 [BV], P <.05). The most improvement was observed with LV and BV stimulation at short and intermediate atrioventricular delays (80-120 milliseconds), independent of ischemic or idiopathic origin. Conclusions CRT improves hemodynamic performance in patients with heart failure with intraventricular conduction delays. Doppler echocardiography allows noninvasive evaluation of acute CRT effects in patients with heart failure. In particular, FT, AOVTI, and MPI are useful parameters for noninvasive follow-up and optimization of pacing parameters. (Am Heart J 2002;143:34-44.)