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Prognostic significance of persistent restrictive filling pattern after cardiac resynchronization therapy

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Abstract

Background

Cardiac resynchronization therapy (CRT) may improve left ventricular (LV) diastolic dysfunction as well as systolic dysfunction. Diastolic dysfunction is a key for prognosis in patients with heart failure; therefore, we aimed to clarify the impact of CRT on diastolic function and prognosis.

Methods

In 67 patients who underwent CRT, LV diastolic function was assessed by pulsed Doppler transmitral flow pattern at baseline and 1 week after CRT, and classified into restrictive filling pattern (RFP) and non-RFP groups. Volume responders were defined by reduction of LV end-systolic volume >15 % at 6 months after CRT. The clinical endpoint comprised death from any cause or unplanned hospitalization for a major cardiovascular event (MACE).

Results

During the follow-up period (479 ± 252 days), 26 patients (38.8 %) had reached the endpoint of MACE. In Cox proportional hazard analyses, RFP at 1 week after CRT was associated with the endpoints independently of age and New York Heart Association (NYHA) class IV at baseline. Thirty (44.8 %) patients were identified as volume responders, who had better prognosis than non-responders. Patients were classified into 4 groups based on their filling pattern at 1 week after CRT and volume responses. The worst prognosis was observed in the RFP and non-responder group, and the best was observed in the non-RFP and responder group. For the remaining 2 groups with intermediate prognosis, the RFP and responder group showed poorer prognosis compared to the non-RFP and non-responder group.

Conclusions

Persistent RFP after CRT may be a strong prognostic predictor, which should be treated with more intensive therapy to improve the prognosis of patients following CRT.

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Conflict of interest

Grants: Yoshihiro Seo received a research grant from Toshiba Medical Systems Corporation and Kazutaka Aonuma from Hitachi Aloka Medical Ltd. Masayoshi Yamamoto, Naoto Kawamatsu, Kimi Sato, Akinori Sugano, Akiko Atsumi, Yoshie Harimura, Tomoko Machino-Ohtsuka, Fumiko Sakamaki, and Tomoko Ishizu declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Cardiovascular Division, Faculty of Clinical Medicine, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Masayoshi Yamamoto, Yoshihiro Seo, Tomoko Ishizu, Naoto Kawamatsu, Kimi Sato, Akinori Sugano, Akiko Atsumi, Yoshie Harimura, Tomoko Machino-Ohtsuka & Kazutaka Aonuma

  2. Department of Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan

    Fumiko Sakamaki

Authors
  1. Masayoshi Yamamoto
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  2. Yoshihiro Seo
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  3. Tomoko Ishizu
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  4. Naoto Kawamatsu
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  6. Akinori Sugano
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  9. Tomoko Machino-Ohtsuka
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  10. Fumiko Sakamaki
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  11. Kazutaka Aonuma
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Corresponding author

Correspondence to Yoshihiro Seo.

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Yamamoto, M., Seo, Y., Ishizu, T. et al. Prognostic significance of persistent restrictive filling pattern after cardiac resynchronization therapy. J Echocardiogr 13, 20–26 (2015). https://doi.org/10.1007/s12574-014-0234-0

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  • DOI: https://doi.org/10.1007/s12574-014-0234-0

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