Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block

Gregory S. Nelson, Ronald D. Berger, Barry J. Fetics, Maurice Talbot, Joshua Hare, David A. Kass, Julio C. Spinelli

Research output: Contribution to journalArticle

655 Citations (Scopus)

Abstract

Background - Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand. Methods and Results - Ten DCM patients with left bundle-branch block (ejection fraction 20±3%, QRS duration 179±3 ms, mean±SEM) underwent cardiac catheterization to measure ventricular and aortic pressure, coronary blood flow, arterial-coronary sinus oxygen difference (ΔAVO2), and MVO2. Data were measured under sinus rhythm or with left ventricular or biventricular pacing/stimulation at the same heart rate. These results were then contrasted to intravenous dobutamine (n=7) titrated to match systolic changes during LV pacing. Systolic function rose quickly and substantially from LV pacing (18±4% rise in arterial pulse pressure, which correlates with cardiac output, and 43±6% increase in dP/dt(max); both P<0.01). However, ΔAVO2 and MVO2 declined -4±2% and -8±6.5%, respectively (both P<0.05). Similar results were obtained with biventricular activation. In contrast, dobutamine raised dP/dt(max) 37±6%, accompanied by a 22±11% rise in per-beat MVO2 (P<0.05 versus pacing). Conclusions - Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.

Original languageEnglish
Pages (from-to)3053-3059
Number of pages7
JournalCirculation
Volume102
Issue number25
StatePublished - Dec 19 2000
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Bundle-Branch Block
Dilated Cardiomyopathy
Costs and Cost Analysis
Dobutamine
Arterial Pressure
Coronary Sinus
Ventricular Pressure
Cardiac Catheterization
Oxygen Consumption
Cardiac Output
Heart Failure
Heart Rate
Oxygen
Blood Pressure
Therapeutics

Keywords

  • Bundle-branch block
  • Heart failure
  • Oxygen
  • Pacing

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. / Nelson, Gregory S.; Berger, Ronald D.; Fetics, Barry J.; Talbot, Maurice; Hare, Joshua; Kass, David A.; Spinelli, Julio C.

In: Circulation, Vol. 102, No. 25, 19.12.2000, p. 3053-3059.

Research output: Contribution to journalArticle

Nelson, Gregory S. ; Berger, Ronald D. ; Fetics, Barry J. ; Talbot, Maurice ; Hare, Joshua ; Kass, David A. ; Spinelli, Julio C. / Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. In: Circulation. 2000 ; Vol. 102, No. 25. pp. 3053-3059.
@article{5145be7f397e43128b9b0d395d3088b0,
title = "Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block",
abstract = "Background - Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand. Methods and Results - Ten DCM patients with left bundle-branch block (ejection fraction 20±3{\%}, QRS duration 179±3 ms, mean±SEM) underwent cardiac catheterization to measure ventricular and aortic pressure, coronary blood flow, arterial-coronary sinus oxygen difference (ΔAVO2), and MVO2. Data were measured under sinus rhythm or with left ventricular or biventricular pacing/stimulation at the same heart rate. These results were then contrasted to intravenous dobutamine (n=7) titrated to match systolic changes during LV pacing. Systolic function rose quickly and substantially from LV pacing (18±4{\%} rise in arterial pulse pressure, which correlates with cardiac output, and 43±6{\%} increase in dP/dt(max); both P<0.01). However, ΔAVO2 and MVO2 declined -4±2{\%} and -8±6.5{\%}, respectively (both P<0.05). Similar results were obtained with biventricular activation. In contrast, dobutamine raised dP/dt(max) 37±6{\%}, accompanied by a 22±11{\%} rise in per-beat MVO2 (P<0.05 versus pacing). Conclusions - Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.",
keywords = "Bundle-branch block, Heart failure, Oxygen, Pacing",
author = "Nelson, {Gregory S.} and Berger, {Ronald D.} and Fetics, {Barry J.} and Maurice Talbot and Joshua Hare and Kass, {David A.} and Spinelli, {Julio C.}",
year = "2000",
month = "12",
day = "19",
language = "English",
volume = "102",
pages = "3053--3059",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "25",

}

TY - JOUR

T1 - Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block

AU - Nelson, Gregory S.

AU - Berger, Ronald D.

AU - Fetics, Barry J.

AU - Talbot, Maurice

AU - Hare, Joshua

AU - Kass, David A.

AU - Spinelli, Julio C.

PY - 2000/12/19

Y1 - 2000/12/19

N2 - Background - Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand. Methods and Results - Ten DCM patients with left bundle-branch block (ejection fraction 20±3%, QRS duration 179±3 ms, mean±SEM) underwent cardiac catheterization to measure ventricular and aortic pressure, coronary blood flow, arterial-coronary sinus oxygen difference (ΔAVO2), and MVO2. Data were measured under sinus rhythm or with left ventricular or biventricular pacing/stimulation at the same heart rate. These results were then contrasted to intravenous dobutamine (n=7) titrated to match systolic changes during LV pacing. Systolic function rose quickly and substantially from LV pacing (18±4% rise in arterial pulse pressure, which correlates with cardiac output, and 43±6% increase in dP/dt(max); both P<0.01). However, ΔAVO2 and MVO2 declined -4±2% and -8±6.5%, respectively (both P<0.05). Similar results were obtained with biventricular activation. In contrast, dobutamine raised dP/dt(max) 37±6%, accompanied by a 22±11% rise in per-beat MVO2 (P<0.05 versus pacing). Conclusions - Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.

AB - Background - Left ventricular or biventricular pacing/stimulation can acutely improve systolic function in patients with dilated cardiomyopathy (DCM) and intraventricular conduction delay by resynchronizing contraction. Most heart failure therapies directly enhancing systolic function do so while concomitantly increasing myocardial oxygen consumption (MVO2). We hypothesized that pacing/stimulation, in contrast, incurs systolic benefits without raising energy demand. Methods and Results - Ten DCM patients with left bundle-branch block (ejection fraction 20±3%, QRS duration 179±3 ms, mean±SEM) underwent cardiac catheterization to measure ventricular and aortic pressure, coronary blood flow, arterial-coronary sinus oxygen difference (ΔAVO2), and MVO2. Data were measured under sinus rhythm or with left ventricular or biventricular pacing/stimulation at the same heart rate. These results were then contrasted to intravenous dobutamine (n=7) titrated to match systolic changes during LV pacing. Systolic function rose quickly and substantially from LV pacing (18±4% rise in arterial pulse pressure, which correlates with cardiac output, and 43±6% increase in dP/dt(max); both P<0.01). However, ΔAVO2 and MVO2 declined -4±2% and -8±6.5%, respectively (both P<0.05). Similar results were obtained with biventricular activation. In contrast, dobutamine raised dP/dt(max) 37±6%, accompanied by a 22±11% rise in per-beat MVO2 (P<0.05 versus pacing). Conclusions - Ventricular resynchronization by left ventricular or biventricular pacing/stimulation in DCM patients with left bundle-branch block acutely enhances systolic function while modestly lowering energy cost. This should prove valuable for treating DCM patients with basal dyssynchrony.

KW - Bundle-branch block

KW - Heart failure

KW - Oxygen

KW - Pacing

UR - http://www.scopus.com/inward/record.url?scp=0034687592&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034687592&partnerID=8YFLogxK

M3 - Article

C2 - 11120694

AN - SCOPUS:0034687592

VL - 102

SP - 3053

EP - 3059

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 25

ER -