Conventional echocardiography has described the increase in LV internal dimensions during diastole (> 54 mm) and systolic dimensions (> 45 mm), LV mass (> 70 +/- 9), LV end diastolic volume (> 142 +/- 21 mL), LV end systolic volume
(>41+/-10 mL), EF by Simpson's modified method (< 30%), FS (< 15%), MAPSE (< 12 mm), average TDI of all the walls of LV (<9cm/s), Tie index (> 0.4).
Reduced ejection fraction enhances end systolic volume
, 13 increasing volume overload resulting in dilatation of heart chambers as well as cardiac wall thinning.
One key observation in the hemodynamic response of the Chinese patients versus previously published Parachute data is the much greater improvement in systolic function, specifically EF and end systolic volume
index.[sup], A likely theory may be that the Chinese patients were treated earlier in the progression of HF (i.e., NYHA II) whereby the basal and mid LV function responded better to a reduction in wall stress and improvement in synchronized contraction.
Most importantly, in this subgroup, a strong trend or a statistical significant positive difference was seen in all individual elements of the composite primary endpoint (mortality, worsening heart failure events, quality of life, 6 minutes walking test, end systolic volume
and ejection fraction).
End Systolic Volume
Index, ESV-I (EsV/BSA in [m.sup.2]) and End Diastolic Volume Index, EDV-I (EDV/BSA in [m.sup.2]) calculated from left apical 4-chamber view were 106.05 ml/[m.sup.2] and 143.6 ml/[m.sup.2] respectively.
The primary endpoint of left ventricular end systolic volume
index (LVESVi) reduction as compared to baseline was met by a reduction from 78.2[+ or -]20.3ml/m2at baseline to 53.4[+ or -]17.4ml/m2 at three-month follow-up, which was found to be highly significant.
The main MR sequences include an inversion recovery prepared echo planar imaging perfusion sequence inversion recovery TrueFISP sequence (delayed enhancement) and TrueFISP cine sequence for heart function measurement (including ejection fraction (EF) end diastolic volume (EDV) end systolic volume
(ESV) stroke volume (SV) and cardiac output (CO)).
The primary results, published in the April 25, 2013, edition of The New England Journal of Medicine, showed a 26 percent relative risk reduction in the composite of death, healthcare utilization visits requiring intravenous heart failure therapy, and significant increase in LV end systolic volume
among patients receiving BiV pacing.
End systolic volume
: End systolic volume
(ESV) refers to the volume of blood left in the ventricle following a contraction.
Additional results from the BLOCK HF trial demonstrated a 26% relative risk reduction in the composite of death, healthcare utilization visits requiring IV heart failure therapy, and significant increase in left ventricular end systolic volume
index (LVESVi a measure of cardiac function) among patients receiving BiV pacing, meeting the trial's primary objective.
After 180 days from treatment, the TMZ group showed a smaller end systolic volume
than the placebo group (echocardiographic data), 46.2+/-12 and 52.8+/-13 ml/m2, respectively, p = 0.037.
Efficacy domains included symptomatic changes in NYHA class and the MLHF (Minnesota Living With Heart Failure) questionnaire; functional changes based on 6-minute walk test and maximal oxygen consumption; changes in N-terminal prohormone brain natriuretic peptide; and evidence of remodeling based on ejection fraction scores and end systolic volume