Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

• DOI: 10.1161/01.cir.101.23.2703
• Publication Date: 2012-06-12T00:42:29Z
• Authors: Gregory S. Nelson; Cecilia W. Curry; Bradley T. Wyman; Andrew Kramer; Jerome Declerck; Maurice Talbot; Margaret R. Douglas; Ronald D. Berger; Elliot R. McVeigh; David A. Kass
• Keywords: Isovolumetric contraction; Dilated Cardiomyopathy; Systole

Background —VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of likely to benefit is unclear. We tested predictors responsiveness on the basis global parameters as well directly assessed mechanical dyssynchrony. Methods Results —Twenty-two DCM conduction delay were studied by cardiac catheterization a dual-sensor micromanometer measure LV aortic pressures during sinus rhythm free-wall pacing. Pacing enhanced isovolumetric (dP/dt max ) ejection-phase (pulse pressure, PP) 35±21% 16.4±11%, respectively, these changes correlated ( r =0.7, P =0.001). %ΔdP/dt was weakly predicted baseline QRS =0.6, <0.02), more strongly dP/dt =0.001), best bidiscriminate analysis combining ≤700 mm Hg/s ≥155 ms predict ≥25% %ΔPP ≥10% <0.0005, χ 2 ), no false-positives. Benefit could not be %ΔQRS. To test whether basal dyssynchrony pacing, circumferential strains determined at ≈80 sites throughout tagged MRI 8 7 additional control subjects. Strain variance time maximal shortening indexed dyssynchrony, averaging 28.0±7.1% normal subjects versus 201.4±84.3% Mechanical also =0.85, =0.008). Conclusions —These results show that although key predictor for efficacy delay, information about provides an excellent tool identify responders.