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Prevalence and characteristics of patients with clinical improvement... » Isaúde
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American Heart Journal
2011-03-04 03:00:00

Prevalence and characteristics of patients with clinical improvement but not significant left ventricular reverse remodeling after cardiac resynchronization therapy

Descrição: We appreciate the work by Auger et al, which reported that, although there is a good concordance between echocardiographic and clinical response to cardiac resynchronization therapy (CRT), up to 28% of the population experienced clinical response without significant left ventricular (LV) reverse remodeling. Subjects with such discrepant responses have more frequently ischemic heart failure and show more narrow QRS complex and less LV dyssynchrony than patients with both clinical and echocardiographic response. Their findings are compatible to the results in recent large clinical trials including REVERSE and MIRACLE. In the REVERSE trial, CRT in patients with New York Heart Association I/II heart failure, QRS duration -120 milliseconds, end-diastolic dimension -55 mm, and LV ejection fraction -40% resulted in major structural and functional reverse remodeling at 1 year, with the greatest changes occurring in patients with nonischemic cause of heart failure. Similarly, the findings parallel that in patients in New York Heart Association class III/IV heart failure reported in the MIRACLE trial. As we know, patients with severe ischemic heart failure in previous CRT trials such as MIRACLE and CARE-HF had more cases of old age, male gender, and less severity of LV dyssynchrony symbolized by widened QRS duration and increase of interventricular mechanical delay than nonischemic ones. In addition, Yu et al have analyzed LV systolic dyssynchrony to be the only independent predictor of reverse remodeling after CRT for heart failure. Therefore, we could reason why the echocardiographic nonresponders with clinical improvements are predominantly characterized by ischemic origins and with narrow QRS duration.

Identificador: 10.1016/j.ahj.2011.01.013
Seção: Letters to the Editor
Número: 4
Volume: 161
Página: e21 a e21
Autor: Gen-Min Lin, Yi-Hwei Li, Kai-Min Chu, Chih-Lu Han

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