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Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study [Anatol J Cardiol]
Anatol J Cardiol. 2012; 12(2): 132-141 | DOI: 10.5152/akd.2012.039  

Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study

Marco Pugliese1, Giovanni Minardi2, Andrea Vitali1, Enrico Natale1, Piergiuseppe De Girolamo3, Giordano Zampi2, Massimo Leggio4, Annalisa Chiarelli1, Augusto Pappalardo3, Andrea Avella3, Francesco Laurenzi3, Maria Stella Fera1
1Cardiovascular Intensive Cardiac Unit San Camillo Hospital, Rome, Italy
2Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome-İtaly
3Cardiovascular Arrhythmology Unit, San Camillo Hospital, Rome, Italy
4Cardiovascular Department, Cardiac Rehabilitation Unit, San Filippo Neri Hospital, Rome-Italy

Objective: To understand whether patients with post-ischemic dilated cardiomyopathy and myocardial viability (MV) could benefit from cardiac resynchronization therapy (CRT) in terms of clinical, echocardiographic and neuro- hormonal parameters compared to patients without MV. Methods: One hundred and four consecutive patients were enrolled in a prospective observational cohort study. Using dobutamine stress echocardiography, 2 groups were identified: group A of 51 patients with MV and group B of 53 patients without MV. All patients were implanted with biventricular pacing devices combined with an internal cardioverter-defibrillator. Clinical, echocardiographic and neuro-hormonal param- eters were evaluated at baseline and at six month follow-up. Analysis of variance for repeated measures on each variable suggestive of remod- eling was performed. We considered responder every patient with: decrease of > 15% in left ventricular volumes and/or improvement in left ventricular ejection fraction of > 5% in addition to NYHA class improvement. Results: All the variables improved in both groups (time effect). Comparing the two groups (group effect), the following variables were signifi- cantly better in group A: N-terminal pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic volume after the first week (p=0.035). RR occurred at the first week after CRT only in Group A and was maintained for all the time of this study. The maximum difference of the decrease of left ventricular volumes between the two groups occurred after the first week (p<0.001). Conclusion: Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT.

Keywords: Cardiac resynchronization therapy, dilated cardiomyopathy, ventricular remodeling


İskemik dilate kardiyomiyopatide kardiyak resenkronizasyon yanıtlarına miyokart canlılığının etkisi: Bir prospektif gözlemsel kohort çalışması

Marco Pugliese1, Giovanni Minardi2, Andrea Vitali1, Enrico Natale1, Piergiuseppe De Girolamo3, Giordano Zampi2, Massimo Leggio4, Annalisa Chiarelli1, Augusto Pappalardo3, Andrea Avella3, Francesco Laurenzi3, Maria Stella Fera1
1Cardiovascular Intensive Cardiac Unit San Camillo Hospital, Rome, Italy
2Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome-İtaly
3Cardiovascular Arrhythmology Unit, San Camillo Hospital, Rome, Italy
4Cardiovascular Department, Cardiac Rehabilitation Unit, San Filippo Neri Hospital, Rome-Italy

Amaç: Post-iskemik dilate kardiyomiyopatili ve miyokart canlılığı (MV) olan hastaların, klinik, ekokardiyografik ve nöro-hormonal parametreler açısından, MV olmayan hastalarla karşılaştırıldığında kardiyak resenkronizasyon tedavisinden (KRT) yarar görüp-görmeyeceklerini anlamak. Yöntemler: Prospektif, gözlemsel kohort çalışmaya 104 ardışık hasta dahil edildi. Dobutamin stres ekokardiyografi kullanarak, 2 grup tespit edildi: A grup 51 MV’li hasta ve grup B 53 MV’siz hasta. Tüm hastalara internal kardiyoverter-defibrilatörle kombine biventriküler pacing cihazı konuldu. Klinik olarak, ekokardiyografik ve nöro-hormonal parametreler başlangıç ve altı aylık takipte değerlendirildi. Remodeling düşündüren her değişken hakkında tekrarlayan ölçümler için varyans analizi yapıldı. Aşağıdakileri olan her hasta “cevap veren” olarak düşünüldü: NYHA sınıflamasında düzelmeye ilaveten, sol ventrikül völümlerinde > %15 azalma ve/veya sol ventrikül ejeksiyon fraksiyonunda > %15 düzelme. Bulgular: Tüm değişkenler her iki grupta da (zaman etkisi) düzeldi. İki grup karşılaştırıldığında (grup etkisi), aşağıdaki değişkenler A grubunda anlamlı olarak daha iyi: N-terminal pro-B-tip natriüretik peptid (p=0.02), NYHA sınıf (p=0.003), tersine remodeling (TR) (p=0.007), dP/dt (p=0.005), sol ventrikül ejeksiyon fraksiyonu (p=0.009), 3. ses (p=0.01) ve ilk haftadan sonra sol ventrikül sistol sonu völümü (p=0.035). Tersine remodeling KRT’den sonra ilk haftada sadece A grubunda meydana geldi ve bu çalışmanın tüm süresinde devam etti. İlk haftadan sonra, iki grup arasında maksimum SVSSV’de azalma farkı oluştu (p<0.001). Sonuç: Kardiyak resenkronizasyon tedavisinden ilk hafta sonrasında, MV’li hastalar MV’siz hastalara göre daha iyi önemli bir düzelme göster- diler.

Anahtar Kelimeler: Kardiyak resenkronizasyon tedavisi, dilate kardiyomiyopati, ventriküler remodeling


Marco Pugliese, Giovanni Minardi, Andrea Vitali, Enrico Natale, Piergiuseppe De Girolamo, Giordano Zampi, Massimo Leggio, Annalisa Chiarelli, Augusto Pappalardo, Andrea Avella, Francesco Laurenzi, Maria Stella Fera. Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study. Anatol J Cardiol. 2012; 12(2): 132-141


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