Short-term hemodynamic effects of cardiac resynchronization therapy in patients with heart failure, a narrow QRS duration, and no dyssynchrony

Lynne K. Williams, Susan Ellery, Kiran Patel, Francisco Leyva, Robert A. Bleasdale, Thanh T. Phan, Berthold Stegemann, Vince Paul, Paul Steendijk, Michael Frenneaux

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background-Cardiac resynchronization therapy produces both short-term hemodynamic and long-term symptomatic/mortality benefits in symptomatic heart failure patients with a QRS duration > 120 ms. This is conventionally believed to be due principally to relief of dyssynchrony, although we recently showed that relief of external constraint to left ventricular filling may also play a role. In this study, we evaluated the short-term hemodynamic effects in symptomatic patients with a QRS duration < 120 ms and no evidence of dyssynchrony on conventional criteria and assessed the effects on contractility and external constraint.

Methods and Results-Thirty heart failure patients (New York Heart Association class III/IV) with a left ventricular ejection fraction <= 35% who were in sinus rhythm underwent pressure-volume studies at the time of pacemaker implantation. External constraint, left ventricular stroke work, dP/dtmax, and the slope of the preload recruitable stroke work relation were measured from the end-diastolic pressure-volume relation before and during delivery of biventricular and left ventricular pacing. The following changes were observed during delivery of cardiac resynchronization therapy: Cardiac output increased by 25 +/- 5% (P < 0.05), absolute left ventricular stroke work increased by 26 +/- 5% (P < 0.05), the slope of the preload recruitable stroke work relation increased by 51 +/- 15% (P < 0.05), and dP/dtmax increased by 9 +/- 2% (P < 0.05). External constraint was present in 15 patients and was completely abolished by both biventricular and left ventricular pacing (P < 0.05).

Conclusion-Cardiac resynchronization therapy results in an improvement in short-term hemodynamic variables in patients with a QRS <120 ms related to both contractile improvement and relief of external constraint. These findings provide a potential physiological basis for cardiac resynchronization therapy in this patient population. (Circulation. 2009;120:1687-1694.)

Original languageEnglish
Pages (from-to)1687-1694
Number of pages8
JournalCirculation
Volume120
Issue number17
Early online date12 Oct 2009
DOIs
Publication statusPublished - 27 Oct 2009

Keywords

  • cardiac output
  • heart failure
  • hemodynamics
  • pacing
  • systolic pressure-volume
  • dilated cardiomyopathy
  • parallel conductance
  • hypertonic saline
  • catheter
  • performance
  • delay
  • trial
  • block

Cite this

Short-term hemodynamic effects of cardiac resynchronization therapy in patients with heart failure, a narrow QRS duration, and no dyssynchrony. / Williams, Lynne K.; Ellery, Susan; Patel, Kiran; Leyva, Francisco; Bleasdale, Robert A.; Phan, Thanh T.; Stegemann, Berthold; Paul, Vince; Steendijk, Paul; Frenneaux, Michael.

In: Circulation, Vol. 120, No. 17, 27.10.2009, p. 1687-1694.

Research output: Contribution to journalArticle

Williams, LK, Ellery, S, Patel, K, Leyva, F, Bleasdale, RA, Phan, TT, Stegemann, B, Paul, V, Steendijk, P & Frenneaux, M 2009, 'Short-term hemodynamic effects of cardiac resynchronization therapy in patients with heart failure, a narrow QRS duration, and no dyssynchrony', Circulation, vol. 120, no. 17, pp. 1687-1694. https://doi.org/10.1161/CIRCULATIONAHA.108.799395
Williams, Lynne K. ; Ellery, Susan ; Patel, Kiran ; Leyva, Francisco ; Bleasdale, Robert A. ; Phan, Thanh T. ; Stegemann, Berthold ; Paul, Vince ; Steendijk, Paul ; Frenneaux, Michael. / Short-term hemodynamic effects of cardiac resynchronization therapy in patients with heart failure, a narrow QRS duration, and no dyssynchrony. In: Circulation. 2009 ; Vol. 120, No. 17. pp. 1687-1694.
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abstract = "Background-Cardiac resynchronization therapy produces both short-term hemodynamic and long-term symptomatic/mortality benefits in symptomatic heart failure patients with a QRS duration > 120 ms. This is conventionally believed to be due principally to relief of dyssynchrony, although we recently showed that relief of external constraint to left ventricular filling may also play a role. In this study, we evaluated the short-term hemodynamic effects in symptomatic patients with a QRS duration < 120 ms and no evidence of dyssynchrony on conventional criteria and assessed the effects on contractility and external constraint.Methods and Results-Thirty heart failure patients (New York Heart Association class III/IV) with a left ventricular ejection fraction <= 35{\%} who were in sinus rhythm underwent pressure-volume studies at the time of pacemaker implantation. External constraint, left ventricular stroke work, dP/dtmax, and the slope of the preload recruitable stroke work relation were measured from the end-diastolic pressure-volume relation before and during delivery of biventricular and left ventricular pacing. The following changes were observed during delivery of cardiac resynchronization therapy: Cardiac output increased by 25 +/- 5{\%} (P < 0.05), absolute left ventricular stroke work increased by 26 +/- 5{\%} (P < 0.05), the slope of the preload recruitable stroke work relation increased by 51 +/- 15{\%} (P < 0.05), and dP/dtmax increased by 9 +/- 2{\%} (P < 0.05). External constraint was present in 15 patients and was completely abolished by both biventricular and left ventricular pacing (P < 0.05).Conclusion-Cardiac resynchronization therapy results in an improvement in short-term hemodynamic variables in patients with a QRS <120 ms related to both contractile improvement and relief of external constraint. These findings provide a potential physiological basis for cardiac resynchronization therapy in this patient population. (Circulation. 2009;120:1687-1694.)",
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author = "Williams, {Lynne K.} and Susan Ellery and Kiran Patel and Francisco Leyva and Bleasdale, {Robert A.} and Phan, {Thanh T.} and Berthold Stegemann and Vince Paul and Paul Steendijk and Michael Frenneaux",
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T1 - Short-term hemodynamic effects of cardiac resynchronization therapy in patients with heart failure, a narrow QRS duration, and no dyssynchrony

AU - Williams, Lynne K.

AU - Ellery, Susan

AU - Patel, Kiran

AU - Leyva, Francisco

AU - Bleasdale, Robert A.

AU - Phan, Thanh T.

AU - Stegemann, Berthold

AU - Paul, Vince

AU - Steendijk, Paul

AU - Frenneaux, Michael

PY - 2009/10/27

Y1 - 2009/10/27

N2 - Background-Cardiac resynchronization therapy produces both short-term hemodynamic and long-term symptomatic/mortality benefits in symptomatic heart failure patients with a QRS duration > 120 ms. This is conventionally believed to be due principally to relief of dyssynchrony, although we recently showed that relief of external constraint to left ventricular filling may also play a role. In this study, we evaluated the short-term hemodynamic effects in symptomatic patients with a QRS duration < 120 ms and no evidence of dyssynchrony on conventional criteria and assessed the effects on contractility and external constraint.Methods and Results-Thirty heart failure patients (New York Heart Association class III/IV) with a left ventricular ejection fraction <= 35% who were in sinus rhythm underwent pressure-volume studies at the time of pacemaker implantation. External constraint, left ventricular stroke work, dP/dtmax, and the slope of the preload recruitable stroke work relation were measured from the end-diastolic pressure-volume relation before and during delivery of biventricular and left ventricular pacing. The following changes were observed during delivery of cardiac resynchronization therapy: Cardiac output increased by 25 +/- 5% (P < 0.05), absolute left ventricular stroke work increased by 26 +/- 5% (P < 0.05), the slope of the preload recruitable stroke work relation increased by 51 +/- 15% (P < 0.05), and dP/dtmax increased by 9 +/- 2% (P < 0.05). External constraint was present in 15 patients and was completely abolished by both biventricular and left ventricular pacing (P < 0.05).Conclusion-Cardiac resynchronization therapy results in an improvement in short-term hemodynamic variables in patients with a QRS <120 ms related to both contractile improvement and relief of external constraint. These findings provide a potential physiological basis for cardiac resynchronization therapy in this patient population. (Circulation. 2009;120:1687-1694.)

AB - Background-Cardiac resynchronization therapy produces both short-term hemodynamic and long-term symptomatic/mortality benefits in symptomatic heart failure patients with a QRS duration > 120 ms. This is conventionally believed to be due principally to relief of dyssynchrony, although we recently showed that relief of external constraint to left ventricular filling may also play a role. In this study, we evaluated the short-term hemodynamic effects in symptomatic patients with a QRS duration < 120 ms and no evidence of dyssynchrony on conventional criteria and assessed the effects on contractility and external constraint.Methods and Results-Thirty heart failure patients (New York Heart Association class III/IV) with a left ventricular ejection fraction <= 35% who were in sinus rhythm underwent pressure-volume studies at the time of pacemaker implantation. External constraint, left ventricular stroke work, dP/dtmax, and the slope of the preload recruitable stroke work relation were measured from the end-diastolic pressure-volume relation before and during delivery of biventricular and left ventricular pacing. The following changes were observed during delivery of cardiac resynchronization therapy: Cardiac output increased by 25 +/- 5% (P < 0.05), absolute left ventricular stroke work increased by 26 +/- 5% (P < 0.05), the slope of the preload recruitable stroke work relation increased by 51 +/- 15% (P < 0.05), and dP/dtmax increased by 9 +/- 2% (P < 0.05). External constraint was present in 15 patients and was completely abolished by both biventricular and left ventricular pacing (P < 0.05).Conclusion-Cardiac resynchronization therapy results in an improvement in short-term hemodynamic variables in patients with a QRS <120 ms related to both contractile improvement and relief of external constraint. These findings provide a potential physiological basis for cardiac resynchronization therapy in this patient population. (Circulation. 2009;120:1687-1694.)

KW - cardiac output

KW - heart failure

KW - hemodynamics

KW - pacing

KW - systolic pressure-volume

KW - dilated cardiomyopathy

KW - parallel conductance

KW - hypertonic saline

KW - catheter

KW - performance

KW - delay

KW - trial

KW - block

U2 - 10.1161/CIRCULATIONAHA.108.799395

DO - 10.1161/CIRCULATIONAHA.108.799395

M3 - Article

VL - 120

SP - 1687

EP - 1694

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 17

ER -