The "missing" link between acute hemodynamic effect and clinical response

J Cardiovasc Transl Res. 2012 Apr;5(2):188-95. doi: 10.1007/s12265-011-9331-x. Epub 2011 Nov 17.

Abstract

The hemodynamic, mechanical and electrical effects of cardiac resynchronization therapy (CRT) occur immediate and are lasting as long as CRT is delivered. Therefore, it is reasonable to assume that acute hemodynamic effects should predict long-term outcome. However, in the literature there is more evidence against than in favour of this idea. This raises the question of what factor(s) do relate to the benefit of CRT. There is increasing evidence that dyssynchrony, presumably through the resultant abnormal local mechanical behaviour, induces extensive remodelling, comprising structure, as well as electrophysiological and contractile processes. Resynchronization has been shown to reverse these processes, even in cases of limited hemodynamic improvement. These data may indicate the need for a paradigm shift in order to achieve maximal long-term CRT response.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiac Resynchronization Therapy*
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Ventricles / physiopathology*
  • Hemodynamics*
  • Humans
  • Myocardial Contraction
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / therapy*