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. 2001 May;85(5):514–520. doi: 10.1136/heart.85.5.514

Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure

W Kim 1, P Sogaard 1, P Mortensen 1, H Jensen 1, A Pedersen 1, B Kristensen 1, H Egeblad 1
PMCID: PMC1729749  PMID: 11303000

Abstract

OBJECTIVES—To quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.
DESIGN—Three dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2-7 days) biventricular pacing.
RESULTS—Compared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r2 = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %ΔEDV, %ΔESV, and %ΔFSV.
CONCLUSIONS—In five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.


Keywords: heart failure; left ventricular volume; pacing; three dimensional echocardiography

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Figure 1  .

Figure 1  

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Correlation between percentage changes in forward stroke volume and increase in walking distance by six minute walk test. Patients with the largest increase in forward stroke volume had the greatest improvement in walking distance.

Figure 2  .

Figure 2  

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Correlation between baseline QRS duration and pacing induced changes in end diastolic volume (EDV), end systolic volume (ESV), and forward stroke volume (SV). Patients with the longest baseline QRS duration showed the greatest benefit in terms of reduced left ventricular chamber size and increased forward stroke volume.

Figure 3  .

Figure 3  

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Correlation between pacing induced reduction in QRS duration and changes in end diastolic volume (EDV), end systolic volume (ESV), and forward stroke volume (SV). Patients with the largest reduction in QRS duration showed the greatest haemodynamic benefit.    

Selected References

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