Sogaard Peter, Egeblad Henrik, Pedersen Anders K, Kim Won Yong, Kristensen Bent O, Hansen Peter S, Mortensen Peter T
Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark.
Circulation. 2002 Oct 15;106(16):2078-84. doi: 10.1161/01.cir.0000034512.90874.8e.
Cardiac resynchronization therapy (CRT) by means of simultaneous biventricular pacing improves left ventricular systolic performance and synchrony in patients with heart failure and bundle-branch block. We used tissue tracking and 3D echocardiography to evaluate the impact of sequential CRT with individualized interventricular delay programming.
Twenty consecutive patients with severe heart failure and left bundle-branch block were included. Tissue tracking and 3D echocardiography were carried out before and on the day after pacemaker implantation. Eleven different interventricular delays were examined in each patient. Patients were reexamined after 3 months. Simultaneous CRT immediately reduced the extent of myocardium displaying delayed longitudinal contraction (DLC) from 48.6+/-16% to 23.2+/-13% (P<0.01) and increased left ventricular ejection fraction percentage (LVEF%) from 22.4+/-6% to 29.7+/-5% (P<0.01). However, optimum sequential CRT caused a further reduction in the extent of DLC from 23.2+/-13% to 11.1+/-7.2% (P<0.01), with a simultaneous increase in LVEF% (from 29.7+/-5% to 33.9+/-6%, P<0.01). Three months of optimum sequential CRT further improved LVEF% (from 33.6+/-6% to 38.6+/-7.2%, P<0.01). Tissue tracking detected the segments with DLC, and their location determined optimum interventricular delay programming. Compared with simultaneous CRT, sequential CRT increased diastolic filling time by 7+/-2.5%.
Compared with simultaneous CRT, sequential CRT significantly improves left ventricular systolic and diastolic performance. Tissue tracking can be used to select optimum interventricular delay during CRT.
通过双心室同步起搏进行的心脏再同步治疗（CRT）可改善心力衰竭合并束支传导阻滞患者的左心室收缩功能和同步性。我们采用组织追踪和三维超声心动图来评估个体化心室间延迟程控的序贯CRT的效果。
纳入20例连续的重度心力衰竭合并左束支传导阻滞患者。在起搏器植入前及植入后当天进行组织追踪和三维超声心动图检查。每位患者检查11种不同的心室间延迟。3个月后对患者进行复查。同步CRT立即减少了显示延迟纵向收缩（DLC）的心肌范围，从48.6±16%降至23.2±13%（P<0.01），并使左心室射血分数百分比（LVEF%）从22.4±6%提高到29.7±5%（P<0.01）。然而，最佳序贯CRT使DLC范围进一步从23.2±13%降至11.1±7.2%（P<0.01），同时LVEF%增加（从29.7±5%增至33.9±6%，P<0.01）。3个月的最佳序贯CRT进一步改善了LVEF%（从33.6±6%增至38.6±7.2%，P<0.01）。组织追踪检测到有DLC的节段，其位置确定了最佳心室间延迟程控。与同步CRT相比，序贯CRT使舒张期充盈时间增加了7±2.5%。
与同步CRT相比，序贯CRT显著改善了左心室的收缩和舒张功能。组织追踪可用于在CRT期间选择最佳心室间延迟。
