P435Aortic preejection time is not associated with intraventricular dyssynchrony in CRT responders


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Abstract

Background: Echocardiographic aortic preejection time of more than 140 ms is considered to be associated with significant intraventricular dyssynchrony. However this assumption was not evaluated after successful CRT.Objective:To evaluate the evolution of the aortic preejection time in a population of CRT responders and to compare it with the evolution of more specific parameters of intraventricular dyssynchrony.Methods: 15 consecutive CHF patients with dilated cardiomyopathy (DCM), with left bundle branch block (mean age 62 ± 10 years, 6 women, NYHA class 3,2±0,4, LVEF 27±4%) were implanted with a biventricular pace-maker for CRT . All patients were in sinus rhythm and they have significant baseline mechanical intraventricular dyssynchrony as assessed by several echocardiographic parameters: septal-to-posterior wall motion delay in short axis view with M mode (SPWMD), the presence of septal flash, the aortic preejection time and the time difference in peak septal wall–to–posterior wall strain on speckle tracking radial strain.Results: All patients were responders to CRT at 12 months follow-up: NYHA class significantly decreased to 1,4±0,4 (p < 0.005), LV end systolic volume decreased from 136±33ml to 89±36ml (p < 0.001), LVEF increased to 43±6% (p< 0.0001). This response was associated with a significant improvement of all parameters of intraventricular dyssynchrony except aortic preejection time: SPWMD decreased from 297±65ms to 37±9ms (p<0.0001), septal flash disappeared in all patients (p < 0,003) and the time difference in peak septal wall–to–posterior wall strain on speckle tracking radial strain decreased from 260±58ms to 52±12 ms (p<0.001). Aortic preejection time did not changed (156±23ms at baseline vs. 165±30ms at 12 month follow-up, p=NS).Conclusion : Aortic preejection time is not correlated with intraventricular dyssynchrony or LV remodeling nor is improved in responders to CRT. Further studies on larger population are necessary in order to evaluate the power of the aortic preejection time in detecting LV dyssynchrony and in predicting the response to CRT .

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