CLINICS

Clinics (Sao Paulo). 2017 July; 72(7): 432-437.
doi:10.6061/clinics/2017(07)08

Copyright © 2017 CLINICS

Abnormal diastolic function underlies the different beneficial effects of cardiac resynchronization therapy on ischemic and non-ischemic cardiomyopathy

Qi Wang I # , Kang-Yu Chen I # , Fei Yu I , Hao Su I , Chun-Sheng An I , Yang Hu I , Dong-Mei Yang I , Jian Xu I , Ji Yan I II *

Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China

Cardiovascular Institute of Anhui, Hefei, China

*Corresponding author. E-mail: yanji111111@yeah.net

# These authors contributed equally.

received January 24, 2017; revised March 20, 2017; accepted May 17, 2017.

Abstract

OBJECTIVES:

To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes.

METHODS:

The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters.

RESULTS:

The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy.

CONCLUSIONS:

This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.

Keywords: Heart Failure, Cardiac Resynchronization Therapy, Diastole


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