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      Wall Thickness, Pulmonary Hypertension, and Diastolic Filling Abnormalities Predict Response to Postoperative Biventricular Pacing

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          Abstract

          Objective

          Post-cardiopulmonary bypass biventricular pacing improves hemodynamics but without clearly defined predictors of response. Based on preclinical studies and prior observations, it was suspected that diastolic dysfunction or pulmonary hypertension is predictive of hemodynamic benefit.

          Design

          Randomized controlled study of temporary biventricular pacing after cardiopulmonary bypass.

          Setting

          Single-center study at university-affiliated tertiary care hospital.

          Interventions

          Patients who underwent bypass with pre-operative ejection fraction ≤40% and QRS duration ≥100 ms or double-valve surgery were enrolled. At 3 time points between separation from bypass and postoperative day 1, pacing delays were varied to optimize hemodynamics.

          Participants

          Data from 43 patients were analyzed.

          Measurements and Main Results

          Cardiac output and arterial pressure were measured under no pacing, atrial pacing, and biventricular pacing. Preoperative echocardiograms and pulmonary artery catheterizations were reviewed, and measures of both systolic and diastolic function were compared to hemodynamic response. Early after separation, improvement in cardiac output was positively correlated with pulmonary vascular resistance (R 2 = 0.97, p < 0.001), ventricle wall thickness (R 2 = 0.72, p = 0.002)), and E/e′, a measure of abnormal diastolic ventricular filling velocity (R 2 = 0.56, p = 0.04). Similar trends were seen with mean arterial pressure. QRS duration and ejection fraction did not correlate significantly with improvements in hemodynamics.

          Conclusions

          There may be an effect of biventricular pacing related to amelioration of abnormal diastolic filling patterns rather than electrical resynchronization in the postoperative state.

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          Author and article information

          Journal
          9110208
          1195
          J Cardiothorac Vasc Anesth
          J. Cardiothorac. Vasc. Anesth.
          Journal of cardiothoracic and vascular anesthesia
          1053-0770
          1532-8422
          27 November 2017
          07 February 2015
          October 2015
          29 November 2017
          : 29
          : 5
          : 1155-1161
          Affiliations
          [* ]Department of Medicine, Columbia University, New York, NY
          []Department of Surgery, Columbia University, New York, NY
          []Department of Biostatistics, Columbia University, New York, NY
          Author notes
          Address reprint requests to Henry M. Spotnitz, MD, Department of Surgery, Columbia University Medical Center, 622 West 168th Street, Vanderbilt Clinic, Room 1010, New York, NY 10032. hms2@ 123456cumc.columbia.edu
          Article
          PMC5706646 PMC5706646 5706646 nihpa922835
          10.1053/j.jvca.2015.02.010
          5706646
          25998068
          24df86fb-b95a-4c76-a7dd-d4d6a8f81b7b
          History
          Categories
          Article

          diastolic function,biventricular pacing,cardiopulmonary bypass,pulmonary hypertension

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