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    Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure
    (Elsevier Science Bv, 2002) Oguz, E; Dagdeviren, B; Bilsel, T; Akdemir, O; Erdinler, I; Akyol, A; Ulufer, T
    Background: Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy. Aims: To assess whether the long-term benefit could be predicted from the echocardiographic parameters. Methods and Results: Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n = 11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n = 5) failed to improve at follow-up (7.6 +/- 5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256 +/- 105 vs. 358 +/- 115, P = 0.14 and 564 +/- 199 vs. 468 +/- 117, P = 0.44, respectively), the QRS width (149 +/- 15 vs. 175 +/- 24 ms, P = 0.05) and the dMR (343 +/- 70 vs. 443 +/- 49 ms, P = 0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P = 0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468 +/- 117 to 676 +/- 216 mmHg/s vs. from 564 +/- 199 to 483 +/- 94, P = 0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness. Conclusion: Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing. (C) 2002 European Society of Cardiology. All rights reserved.
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    Prognostic implication of myocardial texture analysis in idiopathic dilated cardiomyopathy
    (Elsevier Science Bv, 2002) Dagdeviren, B; Akdemir, O; Eren, M; Bolca, O; Oguz, E; Gürlertop, Y; Tezel, T
    Background and aim: Abnormal myocardial acoustic properties have been reported in patients with idiopathic dilated cardiomyopathy (IDC). The aim of this study was to investigate the relationship between quantitative ultrasonic textural alterations of myocardium and clinical outcome in IDC. Methods: Baseline clinical and echocardiographic variables were obtained from 28 patients with IDC. By using a videodensitometric approach, quantitative myocardial texture analysis was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: (MGLdiast - MGLsyst)/MGLdiast x 100. All patients were followed for an average of 11 5 months for the occurrence of cardiac death or repeated hospitalization due to worsening of heart failure. Results: During follow-up, 10 patients experienced cardiac events (6 cardiac deaths and 4 heart failure events). The CV indexes of both septum and PW were significantly lower in patients with cardiac events than those of event free patients (6.8 +/- 9.6% vs. 13.6 +/- 8.2%, P < 0.05 and 5.3 +/- 6.4% vs.15.7 +/- 7.2% P < 0.001, respectively). Univariate analysis defined the following variables as predictors of outcome: PW-CV index (chi(2) = 13.0, P = 0.0003), transmitral E/A ratio (chi(2) = 12.5, P = 0.0004), symptom status (chi(2) = 8.7, P = 0.003), and septum-CV index (chi(2) = 4.7, P = 0.03). Multivariate stepwise regression analysis showed that the PW-CV index (chi(2) = 7.5, P = 0.006) and E/A ratio (chi(2) = 6.5, P = 0.01) were the independent predictors of outcome. The event-free survival rate of patients with PW-CV index < 11% was significantly lower than those with an index greater than or equal to 11 (35.7% vs. 92.8%, P = 0,001). Conclusion: The assessment of severely depressed CV index provides valuable prognostic information in patients with IDC. (C) 2002 European Society of Cardiology. All rights reserved.