Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure

Eur J Heart Fail. 2002 Jan;4(1):83-90. doi: 10.1016/s1388-9842(01)00188-x.


Background: Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy.

Aims: To assess whether the long-term benefit could be predicted from the echocardiographic parameters.

Methods and results: Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n=11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n=5) failed to improve at follow-up (7.6+/-5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256+/-105 vs. 358+/-115, P=0.14 and 564+/-199 vs. 468+/-117, P=0.44, respectively), the QRS width (149+/-15 vs. 175+/-24 ms, P=0.05) and the dMR (343+/-70 vs. 443+/-49 ms, P=0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P=0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468+/-117 to 676+/-216 mmHg/s vs. from 564+/-199 to 483+/-94, P=0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness.

Conclusion: Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Echocardiography, Doppler / methods*
  • Follow-Up Studies
  • Heart Failure / diagnostic imaging*
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial
  • Predictive Value of Tests
  • Probability
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Time Factors
  • Treatment Outcome