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European Journal of Echocardiography Advance Access published online on April 7, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep033
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy

Patrizio Lancellotti1,*, Mario Senechal2, Marie Moonen1, Erwan Donal3, Julien Magne1, Eric Nellessen1, Emilio Attena1, Bernard Cosyns4, Pierre Melon1 and Luc Piérard1

1 Department of Cardiology, University Hospital of Liège, B-4000 Liege, Belgium
2 Hôpital Laval, Québec, Canada
3 CHU Ponchaillou, Rennes, France
4 CHIREC, Braine l’Alleud, Belgium

Received 19 November 2008; accepted after revision 13 March 2009.

* Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address: plancellotti{at}chu.ulg.ac.be


  Abstract

Aims: Lack of response to cardiac resynchronization therapy (CRT) may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on left ventricular (LV) reverse remodelling (decrease in LV end-systolic volume ≥15% after 6 months of CRT).

Methods and results: Fifty-one consecutive patients with heart failure underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve and local contractile reserve (assessed by two-dimensional speckle tracking) in the region of the LV pacing lead. Responders (30 patients) showed a greater exercise-induced increase in left ventricular ejection fraction (LVEF) compared with non-responders (P < 0.001). Contractile reserve was directly related to the improvement in LVEF and to LV reverse remodelling after 6 months of CRT (P < 0.001). A 6.5% exercise-induced increase in LVEF yielded a sensitivity of 90% and a specificity of 85.7% to predict the response after 6 months of CRT. Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders than in non-responders (P < 0.0001).

Conclusion: Myocardial contractile reserve (global and regional) is a strong predictive factor of LV reverse remodelling after CRT.

Keywords: Cardiac resynchronization therapy; Left ventricular dyssynchrony; Viability; Exercise; Echocardiography


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