Early Resynchronization Research Articles

291 Impact of Early Resynchronization in Combination with Color Doppler Ultrasonography on Cumulative Pregnancy Rates in Postpartum Beef Cows

Abstract The objective of this study is to evaluate a GnRH and progesterone-based early resynchronization strategy combined with color Doppler ultrasonography for early pregnancy diagnosis. Postpartum Bos taurus beef cows (n = 375) from four locations were enrolled in a completely randomized design, where cows were randomly assigned to 1 of the 2 treatments: 1) Natural Service (NS), cows were exposed to a 7-d CO-Synch + CIDR protocol followed by fixed-time artificial insemination (day 0). On day 15, cows were exposed to natural service for the remainder of the study; or 2) Early Resynchronization (ER), cows were exposed to a 7-d CO-Synch + CIDR protocol followed by fixed-time artificial insemination (day 0). On day 15, a controlled internal drug release (CIDR) device was inserted. On day 20, CIDR was removed, and pregnancy was estimated based on luteal blood perfusion using color Doppler ultrasonography. Non-pregnant cows received a 25-mg injection of prostaglandin F2α at CIDR removal and were fixed-timed-AI concurrently with a 100-μg injection of GnRH 60 to 66 h later. Pregnancy diagnosis and fetal aging were performed on day 53 using conventional ultrasonography. Pregnancy rate to the first AI was greater (P = 0.03) for NS compared with ER (70.25% vs 59.29%, respectively). Pregnancy rates for the second service were also greater (P = 0.01) for NS compared with ER (65.67 vs 42.93%, respectively). Cumulative pregnancy rates to AI did not differ between treatments (P = 0.38); however, cumulative pregnancy rates (first and second service) were greater (P < 0.01) for NS compared with ER (90 vs 77.73%, respectively). In conclusion, the proposed early resynchronization strategy using color Doppler ultrasonography resulted in fewer pregnancies compared with natural service as the second service strategy. Moreover, the proposed ER decreased pregnancy rates to the first insemination, indicating a detrimental effect of ER on pregnancy establishment.

Early resynchronization of follicular wave emergence among Nelore cattle using injectable and intravaginal progesterone for three timed artificial inseminations

Follicular dynamics and pregnancy per AI (P/AI) of cattle submitted to resynchronization 13 d after TAI using a progesterone (P4) insert and supplementary injectable progesterone (iP4) were determined. There was synchronization of ovulation timing imposed (Day 0 = expected estrus; Experiment 1). On Day 13, animals were assigned to: control (only P4 insert; 15 cows and 13 heifers) and iP4 (P4 insert+100 mg iP4; 13 cows and 12 heifers) groups, and submitted to daily ovarian ultrasonography and blood collection (Day 13 to Day 22). In Experiment 2, 760 suckled cows and 498 heifers were submitted to a TAI on Day 0 and assigned into control and iP4 groups on Day 13. In animals with luteolysis on Day 22, there was a second TAI on Day 24, and on Day 37 were subjected to the opposite treatments as imposed in first resynchronization procedure. On Day 37, there was pregnancy diagnosis in animals with functional CL. The third TAI was performed on Day 48. Day of follicular wave emergence did not differ between groups and parities. Dominant follicles were larger in cows than heifers, and in animals of the control group on Day 24. Greater P4 concentrations were detected on Day 14 and Day 15 in the iP4-treated animals. Luteolysis occurred earlier in cows than heifers. Overall P/AI percentage as a result of second and third TAIs, regardless of parity, was greater in iP4-treated animals. In conclusion, females treated with a supplementary iP4 had a greater plasma P4 concentration and P/AI, but there was no effect of iP4 treatment on synchrony of timing of follicular wave.

Timing of early resynchronization protocols affects subsequent pregnancy outcome in dairy cows

The aim of this study was to evaluate the outcomes of an early resynchronization protocol (Resynch) initiated at different timepoints after timed artificial insemination (TAI) and with unknown pregnancy status. Holstein cows (n = 164) were submitted to the following TAI protocol: D0, insertion of an intravaginal progesterone (P4) device and 2 mg im estradiol benzoate (EB); D8, removal of P4 device and treatment with 0.5 mg im sodium cloprostenol (PGF); D9, 0.1 mg im Lecirelin (LEC); and D10, TAI1. Cows were then randomly assigned to Resynch protocols starting either on day 20 (Resynch20D, n = 82) or 25 after TAI1 (Resynch25D, n = 82) with the insertion of a new P4 device and EB treatment. In both groups, P4 device was removed on day 8 after the beginning of Resynch, the same day of pregnancy diagnosis by ultrasonography. In pregnant cows there was no further action. Non-pregnant cows were treated with 0.5 mg im PGF, had a blood sample collected for serum P4 analysis and we measured and recorded the size of the largest follicle and the presence or absence of a corpus luteum (CL). One day later, cows were treated with 0.1 mg im LEC and TAI2 occurred 12–14 h later. The diameter of the largest follicle and serum P4 were compared between groups by ANOVA for the main effects of treatment, presence of a CL, and their interaction, whereas pregnancy per artificial insemination (P/AI) and the percentage of cows with a CL on the day of ultrasonography were analyzed using the Chi-square test. Follicle diameter on day 8 of Resynch was greater for cows in the Resynch20D group compared with Resynch25D (15.9 ± 3.9 vs 12.2 ± 2.5 mm, respectively; P = 0.046). The Resynch25D group had a greater percentage of cows with a CL (51.9 vs 18.9%, respectively; P = 0.0008) and higher serum P4 (2.8 ± 1.1 vs 1.7 ± 0.8 ng/mL; P = 0.041) at the end of the protocol compared with Resynch20D. P/AI at TAI1 was 35.4 and 36.6% (P > 0.10) for cows enrolled in Resynch20D and Resynch25D groups, respectively. P/AI to TAI2, after Resynch protocols, was greater in Resynch25D than Resynch20D (44.2 vs 22.6%, respectively; P < 0.05). In conclusion, starting an early resynchronization protocol 25 days after TAI increases P/AI compared with starting 20 days after TAI, and this was associated with a presumed greater proportion of cows with a functional CL at the moment of P4 device removal.

Fixed timed artificial insemination and early resynchronization of ovulation in different categories of ewes in grazing system: Response of multiparous, nulliparous, and lactating ewes during the breeding season

The aims of this study were to: 1) determine if the insertion of a second MAP sponge in ewes 12 days after the first FTAI affects the pregnancy rate; 2) compare the responses to resynchronization protocol in multiparous and nulliparous ewes; and 3) compare the responses to resynchronization protocol in multiparous and postpartum lactating ewes. Three trials were performed with 186 Corriedale ewes: 111 multiparous [(control – CON (n = 60) and synchronization – SYNC groups (n = 51)], forty-two 1.5 yr-old nulliparous (group NUL), and 33 lactating ewes with at least 28 postpartum (group PtP). All ewes were treated with a MAP sponge for 6 days. Twenty-four hours before the sponge withdrawal, all animals received 0.24 mg of cloprostenol sodium and 300 IU of eCG, and 0.05 mg of gonadorelin 36 h after sponge withdrawal and artificially inseminated (AI) 27-30 h after the GnRH administration (Day 0). A second intravaginal sponge was inserted to all groups (except for SYNC group), on Day 12. On Day 17, early pregnancy diagnosis was performed with doppler ultrasound in all ewes. Sponge withdrawal occurred on Day 18, and a new GnRH dose (0.05 mg) was administrated 36 h after it. Once again, AI 27-30 h after the GnRH administration. A final pregnancy diagnosis on Day 42 was performed in all ewes for confirmation of first diagnosis and the data were confirmed by parturition. Ewes in all groups presented estrus signs (SYNCH – 94.1%; CON – 71.7%; NUL – 83.3%; PtP – 39.4% at first AI and CON – 65.2%; NUL – 76.5%; PtP – 62.5% at the second). Pregnancy rate and pregnancy loss were not different between synchronized and resynchronized multiparous ewes (SYNCH – 56.9% vs. CON – 58.3% pregnant at D42 and SYNCH – 5.9% vs. CON – 7.1% fetal loss at D42). No differences were found between resynchronized multiparous and nulliparous ewes at the first FTAI, only fecundity was higher in multiparous ewes [CON – 0.88 vs. NUL – 0.62 (P = 0.04)]. Resynchronized multiparous ewes had higher reproductive performance than postpartum ewes that only presented pregnancy after the second FTAI [CON – 73.3% vs. PtP – 15.1% total pregnancy (P = 0.003)]. Overall, synchronization-resynchronization FTAI treatments may be included in reproductive programs in nulliparous ewes, but the treatments cannot superimpose to the limiting conditions imposed by postpartum lactating status. The resynchronization treatments allow to include practical managements with no deleterious effects in the results of the first FTAI.

Early resynchronization protocols for goats: Progestogens can be used prior to an early pregnancy diagnosis without affecting corpus luteum functionality.

This study aimed to evaluate the exogenous progesterone (P4) effect on the luteal function from Day 16 to Day 21 of the oestrous cycle in inseminated goats with unknown pregnancy status. A total of 54 does passed through a short progestin-based synchronization protocol and, on Day 16 of the following oestrous cycle, 27 does received a new P4 device which was retained until Day 21. Blood samples were collected daily from all does during this period, as well as on Day 24. Pregnancy diagnoses were performed on Day 30. Serum P4 values from 26 animals (GNPSP : Group of non-pregnant does with second sponge: n=8; GNPNSP : Group of non-pregnant does without second sponge: n=6; GPSP : Group of pregnant does with second sponge: n=5; GPNSP : Group of pregnant does without second sponge: n=7) were determined by radioimmunoassay commercial kits. No P4 differences were found between groups (GNPSP : 3.1±2.8; 1.7±1.8; 0.4±1.0; and 0.0±0.0 vs. GNPNSP : 4.4±1.8; 3.0±2.2; 0.8±0.8; and 0.0±0.0 or GPSP : 4.2±1.0; 3.4±0.6; 3.3±1.6; 3.2±0.9; 3.6±1.2; 3.5±1.3; 2.7±1.3 vs. GPNSP : 4.4±1.6; 3.6±1.5; 3.7±1.5; 3.8±1.4; 3.2±1.2; 3.1±1.2; 3.6±1.1; D16, D17, D18, D19, D20, D21, D24, respectively) or for the interaction of group and time. In conclusion, a second progestogen device had no effect on luteolysis or early pregnancy in the following oestrous cycle.

Development of a novel 21-day reinsemination program, ReBreed21, in Bos indicus heifers

The aim was to develop a program for resynchronization of ovulation (ReBreed21) that allowed reinsemination of non-pregnant Bos indicus heifers every 21 d using timed AI (TAI) without the need for detection of estrus. The Rebreed21 program begins 12 d after previous TAI (Day 0) by inserting an intravaginal P4 implant (Day 12) that is removed 7 d later (Day 19) combined with treatment with 300 IU of eCG. On Day 21, early pregnancy diagnosis (Doppler PD) is performed based on CL vascularity. Non-pregnant (NP) heifers immediately received AI combined with 100 μg of GnRH. The program is replicated 12 d after second TAI to produce a breeding season (BS) of 42 d with 3 potential TAIs. Two experiments were conducted as a proof of concept for this rapid rebreeding program. In Experiment 1, 76 heifers were enrolled in ReBreed21, as explained above. In Experiment 2, 300 Nellore heifers were synchronized for 1st TAI and randomly assigned to one of two groups: ReBreed21 (n = 147) or another early resynchronization procedure, Resynch14 (n = 153) with P4 implant inserted 14 d after previous TAI plus 50 mg of long-acting injectable P4; 8 d later P4 implant removed (Day 22) and early Doppler PD performed; NP heifers received 150 μg of cloprostenol, 0.5 mg of ECP, and 300 IU of eCG with TAI on Day 24. In both experiments, the largest follicle (LF) was measured at each Resynch TAI. Ultrasound was later used to confirm the early Doppler PD and to determine ovulation (OV) to Resynch at 12 d after TAI in ReBreed21 (Day 33 of pregnancy) and 14 d after TAI in Resynch14 (Day 38 of pregnancy). Final PD was performed 40 d after 3rd TAI. Results for Experiment 1 were: diameter of LF 11.8 ± 0.23 mm; 88.9% OV; 20.5% false positives; 38.1% P/AI at 1st TAI; 44.4% overall P/AI for ReBreed21 TAIs; 72.3% total pregnant at end of BS. In experiment 2, Rebreed21 vs. Resynch14 were different for: diameter of LF (10.9 ± 0.17 vs. 10.0 ± 0.17 mm, P = 0.0003), heifers with LF < 8.5 mm (10.2 vs. 26.4%, P = 0.04), or LF ≥ 11 mm (50.0 vs. 37.2%, P = 0.001), and P/AI at first TAI (29.3% [43/147] vs. 20.3% [31/153], P = 0.074) but similar for OV (overall 86.8% [239/275], P = 0.82), false positives (P = 0.52) overall P/AI for Resynch TAIs (33.6 vs. 28.8%, P = 0.4), and total pregnant at end of BS (58.5% [86/147] vs. 55.6% [85/153], P = 0.64). In addition, median time to pregnancy was 9 d earlier (P = 0.0007) for ReBreed21 than Resynch14. Thus, ReBreed21 is a novel protocol that allows earlier reinseminations than Resynch14 but with similar fertility.

Early resynchronization of non-pregnant beef cows based in corpus luteum blood flow evaluation 21 days after Timed-AI

The study aimed to verify whether a hormone protocol started at Day 13 (D13) after Timed Artificial Insemination (TAI) influences the conception rate. Nelore cows (primiparous and multiparous) from two commercial beef farms (n = 1,431) were first TAI (D0). Timed AI was performed in lots (TAI Lots) ranging from 187 to 346 cows. On D13, regarding the TAI lot, cows were assigned for either receiving (Resynch group, n = 1,002) or not (Control group, a subset of approximately 30%, n = 429) another hormone protocol for resynchronization. The same hormone protocol was used for the first TAI and for the resynchronization, except for 1 mg instead of 2 mg of estradiol benzoate (EB) at the begging of the protocol. Eight days later (D21), the Resynch group was checked for corpus luteum blood flow by color Doppler ultrasonography, and in those detected as non-pregnant, the protocol was completed and a 2nd TAI was performed at D23. Pregnancy diagnosis was later (D30) performed by B-mode ultrasonography in the control group and confirmed in the presumptive pregnant cows from the 1st TAI of the Resynch group. The remaining cows were checked for pregnancy 30 days after the 2nd TAI (experimental Day 53). The statistical model to explain conception rate considered the effects of Group (Control or Resynch), Farm, Parity (primiparous or multiparous), Sire, Technician (who perform AI), TAI Lot and pertinent interactions (Group*Parity, Group*Farm and Group*TAI Lot). The statistical analyses of the model were performed using the Proc Glimmix (SAS virtual University Edition). The conception rate for the 1st TAI was similar (P > 0.4) between Control (50.3%, 216/429) and Resynch group (52.6%, 527/1002). The positive predictive diagnostic on D21 showed high relation with PD30 (90.7%, 527/581). In Resynch group, non-pregnant cows (n = 421, 1002 minus 581) were re-inseminated. The conception rate of the 2nd TAI (42.8%, 180/421) was affected (P < 0.002) by side effects of the Farm (48.5 vs. 33.1%) and Parity (51.2 vs. 40.3%, for multiparous vs. primiparous, p < 0.001). Nevertheless, after the 2 TAIs of the Resynch group, the cumulative conception rate was 70.5% (707/1002). In conclusion, the early resynchronization of cows with a low (1 mg) EB dose and progesterone device at D13 after TAI can be used as a strategy to reduce conception interval in beef cattle, and thus to increase the number of pregnant cows from artificial insemination after the breeding season.

A novel strategy for resynchronization of ovulation in Nelore cows using injectable progesterone (P4) and P4 releasing devices to perform two timed inseminations within 22 days.

We aimed to evaluate the reproductive performance of Nelore lactating cows submitted to a resynchronization 12days after timed artificial insemination (TAI) with or without a long-acting progesterone (P4-LA) treatment. Nelore cows were submitted to a P4/oestradiol-based TAI protocol (D0=insemination). On D12, cows in the control group (n=184) received a new P4 intravaginal device (0.96g), whereas cows in the P4-LA group (n=192) received the P4 device and 75mg P4-LA. Cows identified as non-pregnant (n=120) by regression of corpus luteum using colour Doppler ultrasonography on D20 had the P4 device removed and received 500ug of sodium cloprostenol, 1mg of oestradiol cypionate and 300IU of eCG and were re-inseminated on D22. There was no difference (p>0.10) in the pregnancy rate at D20, D30 and D60 after first TAI between the control (69%, 59.7% and 57%, respectively) and P4-LA (67%, 55.7%, and 55.2%, respectively) groups. Pregnancy losses were similar between both groups (p>0.1). For cows submitted to the second TAI, the pre-ovulatory follicle size did not differ (p>0.1), but the oestrous detection and pregnancy rates were greater (p<0.05) in the P4-LA group (92.2% [59/64] and 60.9% [39/64], respectively) than in controls (75% [42/56] and 44.6% [25/56]). The cumulative pregnancy rate after two TAIs did not differ (p>0.1) between control (73.3% [135/184]) and P4-LA (76% [146/192]) groups. The use of P4-LA at 12days after TAI potentially increases the pregnancy rates for a new early resynchronization strategy associated with the Doppler imaging for pregnancy diagnosis and results in an alternative to perform two TAIs in 22days in beef cows.

Hormonal protocols for early resynchronization of ovulation in ewes: The use of progestagens, eCG, and inclusion of early pregnancy diagnosis with color Doppler ultrasound

This study aimed to evaluate 1) the effect of inserting an intravaginal sponge containing medroxyprogesterone during the late luteal phase on the corpus luteum (CL) function and endogenous production of P4; 2) the effectiveness of two different equine chorionic gonadotrophin (eCG) doses on synchronization of ovulations for a resynchronization treatment; and 3) the inclusion of an early pregnancy diagnosis in an early resynchronization protocol for ovulation in ewes. For all studies, the synchronization protocol was based on a short-term protocol of six days of progestogen treatment plus one dose of prostaglandin F2alpha, one dose of eCG, and gonadorelin acetate after sponge withdrawal. For the first study, the ewes were mated with fertile rams; a second sponge was inserted in half of these ewes 12 days later, and blood samples were collected daily for six days, until sponge withdrawal. For the second study, the ewes were not mated, and received a second sponge during the same period, after which they were divided into three groups according to eCG dose (0, 200, or 300 IU). In the third study, all ewes were artificially inseminated and received the second sponge during the same period. At sponge withdrawal, pregnancy was diagnosed by color Doppler ultrasonography (DUS) of the CL, and only non-pregnant ewes were re-inseminated two days later. In the first study, serum progesterone values were similar regardless of whether an intravaginal sponge had been inserted. In the second study, the ovulation time was more concentrated in those ewes which received 200 IU of eCG. In the third study, there was no difference between the experimental groups (with or without a previous pregnancy diagnosis) in pregnancy rate at the first insemination, accumulated pregnancy rate, and pregnancy loss. The insertion of an intravaginal sponge impregnated with medroxyprogesterone acetate did not affect the endogenous production of P4. The application of 200 IU of eCG provided the best result with regard to the synchronization of ovulations in the resynchronization treatment. Also, the inclusion of an early pregnancy diagnosis with DUS is useful and improves the general results of resynchronization programs, shortening the total working period.

Early Cardiac Resynchronization Therapy (CRT) improves the outcome in Heart Failure (HF) patients with Left Bundle Branch Block (LBBB)

Not available.

Effect of early or late resynchronization based on different methods of pregnancy diagnosis on reproductive performance of dairy cows

The aim of this study was to compare the reproductive performance of dairy cows subjected to early (ER) or late (LR) resynchronization programs after nonpregnancy diagnoses based on either pregnancy-associated glycoproteins (PAG) ELISA or transrectal palpation, respectively. In addition, the accuracy of the PAG ELISA for early pregnancy diagnosis was assessed. Lactating Holstein cows were subjected to a Presynch-Ovsynch protocol with timed artificial insemination (AI) performed between 61 and 74 DIM. On the day of the first postpartum AI, 1,093 cows were blocked by parity and assigned randomly to treatments; however, because of attrition, 452 ER and 520 LR cows were considered for the statistical analyses. After the first postpartum AI, cows were observed daily for signs of estrus and inseminated on the same day of detected estrus. Cows from ER that were not reinseminated in estrus received the first GnRH injection of the Ovsynch protocol for resynchronization 2d before pregnancy diagnosis. On d 28 after the previous AI (d 27 to 34), pregnancy status was determined by PAG ELISA, and nonpregnant cows continued on the Ovsynch protocol for reinsemination. Pregnant cows had pregnancy status reconfirmed on d 46 after AI (d 35 to 52) by transrectal palpation, and those that lost the pregnancies were resynchronized. Cows assigned to LR had pregnancy diagnosed by transrectal palpation on d 46 after AI (d 35 to 52) and nonpregnant cows were resynchronized with the Ovsynch protocol. Blood was sampled on d 28 after AI (d 27 to 34) from cows in both treatments that had not been reinseminated on estrus and again on d 46 after AI (d 35 to 52) for assessment of PAG ELISA to determine the accuracy of the test. Cows were subjected to treatments for 72d after the first insemination. Pregnancy per AI (P/AI) at first postpartum timed AI did not differ between treatments and averaged 28.9%. The proportion of nonpregnant cows that were resynchronized and received timed AI was greater for ER than for LR (30.0 vs. 7.6%). Cows in ER had a shorter interval between inseminations when inseminated following spontaneous estrus (21.7±1.1 vs. 27.8±0.8d) or after timed AI (35.3±1.2 vs. 55.2±1.4d). Nevertheless, the ER did not affect the rate of pregnancy (adjusted hazard ratio=1.23; 95% confidence interval=0.94 to 1.61) or the median days postpartum to pregnancy (ER=132 vs. LR=140). A total of 2,129 PAG ELISA were evaluated. Overall, sensitivity, specificity, and positive and negative predictive values averaged 95.1, 89.0, 90.1, and 94.5%, respectively, and the accuracy was 92.1%. In conclusion, PAG ELISA for early diagnosis of pregnancy had acceptable accuracy, but early resynchronization after nonpregnancy diagnosis with PAG ELISA did not improve the rate of pregnancy or reduce days open in dairy cows continuously observed for estrus.

Effect of interval to resynchronization of ovulation on fertility of lactating Holstein cows when using transrectal ultrasonography or a pregnancy-associated glycoprotein enzyme-linked immunosorbent assay to diagnose pregnancy status

The objective of this study was to compare 2 strategies for resynchronization of ovulation based on nonpregnant diagnoses using transrectal ultrasonography or a pregnancy-associated glycoprotein (PAG) ELISA. Lactating Holstein cows (n=1,038) were submitted for first postpartum timed artificial insemination (TAI) using a Presynch+Ovsynch protocol. After the initial breeding, cows were randomly assigned to initiate resynchronization 25 d (D25) or 32 d (D32) later. Pregnancy status of cows initiating Resynch 25 d after TAI was determined 27 d after TAI by using a PAG ELISA, whereas pregnancy status of cows initiating Resynch 32 d after TAI was determined 39 d after TAI using transrectal ultrasonography. Cows diagnosed as not pregnant continued the Resynch protocol by receiving an injection of PGF2α 7 d after the initial GnRH injection and a second GnRH injection 54h after the PGF2α injection. Cows in both treatments were inseminated approximately 16h after the second GnRH injection. Blood samples for analysis of progesterone (P4) were collected at the first GnRH injection of each Resynch protocol. Pregnancies per AI (P/AI) of nonpregnant cows initiating Resynch 25 vs. 32 d after first postpartum TAI did not differ 39 d after TAI and were 28.3 vs. 30.9% for D25 vs. D32 cows, respectively. Mean P4 at the first GnRH injection of Resynch was greater for D32 than for D25 cows (3.67±0.22 vs. 2.83±0.22 ng/mL), indicating that the Resynch treatments were initiated at different stages of the estrous cycle. After blocking P4 concentration into low (<1.0ng/mL) or high (≥1.0ng/mL) classes, P4 class was not found to affect P/AI 39 d after TAI. Early resynchronization was not found to affect P/AI 39 d after TAI; however, early resynchronization did decrease days between inseminations and the interval from the initial nonpregnant diagnosis to conception. Earlier detection of nonpregnant cows using the PAG ELISA in conjunction with a TAI resynchronization program may improve the rate at which cows become pregnant in a dairy herd compared with transrectal ultrasonography conducted at a later stage after TAI.

Letter by Naqvi and Motallebi Regarding Article, “Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy”

To the Editor: Bleeker et al1 propose that in patients selected on the basis of both electrical and a single mechanical dyssynchrony measure derived from maximum delay during left ventricular (LV) ejection between peak systolic velocities among 4 basal LV segments, immediate resynchronization (of at least 20%) after cardiac resynchronization treatment (CRT) predicts reduction in LV end-systolic volume by at least 10% at 6-month follow-up. The editorial accompanying the article by Bleeker and colleagues2 appropriately “cautions” against relying on a single “dyssynchrony” measure and on “early resynchronization” …

Basal asynchrony and resynchronization with biventricular pacing predict long-term improvement of LV function in heart failure patients.

Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long-term evolution of ventricular function after BiV. Thirty-four patients (NYHA Class III-IV,65.4 +/- 11 years) with large QRS(179 +/- 18 ms)were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow-up(20 +/- 7 months). We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from 20.2 +/- 8.1%(D0) to27.1%+/- 12.6%(follow-up,P < 0.003 vs D0) and RVEF from 28.6%+/- 13%(D0) to 34.3 +/- 11.5%(follow-up,P < 0.03 vs D0). Inter- (DeltaTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from 68.3 +/- 38 ms(D0) to 13.4 +/- 48.5 ms(D8) and1.8 +/- 39.2 ms(follow-up,P < 0.0001 vs D0); and Tab from 45.8 +/- 64.1 msto-18 +/- 68(D8) and-28.3 +/- 53.6 ms(follow-up,P < 0.0001 vs D0). Early inter- and intraventricular resynchronization (DeltaTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow-up. In DCM patients, BiV resynchronizes ventricles early and in the long-term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV.