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The European Society of Cardiology

Standard haemodynamic measurements

Jürgen Vogta,*,1, Johannes Heintzea,1, Barbara Lampa, Bert Hanskyb and Dieter Horstkottea

a Department of Cardiology, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
b Department of Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany

Received 3 May 2004; accepted 24 May 2004.

* Dr. Jürgen Vogt, Department of Cardiology, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Tel.: +49-5731-971258; fax: +49-5731-972194
akohlstaedt{at}hdz-nrw.de

Abstract

Aims Several studies on the acute effect of cardiac resynchronization in patients with advanced heart failure (HF) and left bundle branch block (LBBB) have shown that left and biventricular stimulation increase pulse pressure and contractility, while patients with a QRS complex 150 ms may deteriorate during stimulation.

Methods and results Patients with LBBB, severe HF and a QRS width 150 ms underwent right, left and biventricular stimulation at different AV delays. Acute response was defined as 10% pulse pressure increase. 165 of 188 patients (88%) in sinus rhythm (47 women, mean age 62.5±10 years, ejection fraction 23±8%, NYHA class 3.1±0.3) were regarded acute responders. 10% of 103 patients with dilated cardiomyopathy and 16.5% of 79 patients with coronary artery disease were considered non-responders. 29 patients (81%) with two posterolateral veins were acute responders with 10 of them (33%) being responders in only one vein. 54 patients had an atrio-left ventricular pulse pressure increase of 10.7±10.6%, 9.8±6.4% in 48 patients with atrio-biventricular stimulation. At one-year follow-up, heart failure had significantly improved from NYHA class 3.1±0.4 to 2.1±0.7 (), VO2peak from 12.7±2.8 to 15.9±3.6 ml/min/kg. Left ventricular enddiastolic diameter being an indicator of reverse remodelling decreased from 80.5±10.5 to 73.3±13 ().

Conclusion Haemodynamic testing before CRT allows the identification of acute non-responders as well as the best mode and site of stimulation and the optimal atrioventricular delay in responders.

Key Words: Heart failure • Resynchronization • Stimulation site • Stimulation mode • Pulse pressure • Responder


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