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Title: Additional value of three-dimensional echocardiography in patients with cardiac resynchronization therapy. Author: Deplagne A, Bordachar P, Reant P, Montaudon M, Reuter S, Laborderie J, Dos Santos P, Roudaut R, Jais P, Haissaguerre M, Laurent F, Clementy J, Lafitte S. Journal: Arch Cardiovasc Dis; 2009; 102(6-7):497-508. PubMed ID: 19664569. Abstract: BACKGROUND: There is no gold standard technique for quantification of ventricular dyssynchrony. AIM: To investigate whether additional real-time three-dimensional morphologic assessment of ventricular dyssynchrony affects response after biventricular pacing. METHODS: Forty-one patients with severe heart failure were implanted with a biventricular pacing device and underwent two-dimensional (time dispersion of 12 left ventricular electromechanical delays) and three-dimensional echocardiographic assessment of ventricular dyssynchrony (dispersion of time to minimum regional volume for 16 left ventricular segments), before implantation, 2 days postimplantation with optimization of the pacing interventricular delay and 6 months postimplantation. RESULTS: Individual optimization of sequential biventricular pacing based on three-dimensional ventricular dyssynchrony provided more improvement (p<0.05) in left ventricular ejection fraction and cardiac output than simultaneous biventricular pacing. During the different configurations of sequential biventricular pacing, the changes in three-dimensional ventricular dyssynchrony were highly correlated with those of cardiac output (r=-0.67, p<0.001) and ejection fraction (r=-0.68, p<0.001). The correlations between two-dimensional ventricular dyssynchrony and cardiac output or ejection fraction were significant but less (r=-0.60, p<0.01 and r=-0.56, p<0.05, respectively). After 6 months, 76% of patients were considered responders (10% decrease in end-systolic volume). Before implantation, we observed a significant difference between responders and non-responders in terms of three-dimensional (p<0.05) - but not two-dimensional - ventricular dyssynchrony. CONCLUSION: This prospective study demonstrated the additional value of three-dimensional assessment of ventricular dyssynchrony in predicting response after biventricular pacing and optimizing the pacing configuration.[Abstract] [Full Text] [Related] [New Search]