心脏再同步治疗对扩张型心肌病和心力衰竭患者左心室功能、心肌能量代谢及代谢储备的影响。

The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure.

作者信息

Sundell Jan, Engblom Erik, Koistinen Juhani, Ylitalo Antti, Naum Alexandru, Stolen Kira Q, Kalliokoski Riikka, Nekolla Stephan G, Airaksinen K E Juhani, Bax Jeroen J, Knuuti Juhani

机构信息

Department of Medicine, University Central Hospital, University of Turku, FIN-20521 Turku, Finland.

出版信息

J Am Coll Cardiol. 2004 Mar 17;43(6):1027-33. doi: 10.1016/j.jacc.2003.10.044.

DOI:10.1016/j.jacc.2003.10.044

PMID:15028362

Abstract

OBJECTIVES

The effects of long-term cardiac resynchronization therapy (CRT) on left ventricular (LV) energetics and metabolic reserve were evaluated.

BACKGROUND

Cardiac resynchronization therapy is a new therapy for patients with drug-refractory severe heart failure (HF).

METHODS

Ten patients with idiopathic dilated cardiomyopathy who had undergone implantation of biventricular pacemaker 8 +/- 5 months earlier were studied during two conditions: CRT switched on, and after CRT was switched off for 24 h. Left ventricular function was measured using echocardiography and oxidative metabolism using [(11)C]acetate positron emission tomography. Both measurements were performed at rest and during dobutamine-induced stress (5 microg/kg/min). Basal- and adenosine-stimulated (140 microg/kg/min) myocardial blood flow were quantitated using [(15)O]water.

RESULTS

During CRT off, LV stroke volume was significantly reduced at rest (72 +/- 18 ml vs. 63 +/- 15 ml, p < 0.05), but LV oxidative metabolism (K(mono)) remained unchanged (0.046 +/- 0.008 vs. 0.054 +/- 0.016 min(-1)) leading to a significant deterioration of myocardial efficiency of forward work (from 48.2 +/- 16.7 to 36.6 +/- 11.7 mm Hg.l/g, p < 0.05). During dobutamine-induced stress, stroke volume and K(mono) values were not different whether CRT was on or off. However, myocardial efficiency (56.1 +/- 16.1 vs. 49.8 +/- 18.0 mm Hg.ml.g(-1).min(-1), p = 0.099) and metabolic reserve, the response of K(mono) to dobutamine (0.023 +/- 0.014 vs. 0.013 +/- 0.014 min(-1), p = 0.09), tended to reduce when CRT was switched off. Cardiac resynchronization therapy had no effects on myocardial perfusion. Natriuretic peptides increased significantly during CRT-off period.

CONCLUSIONS

Long-term CRT has beneficial effects on LV function and myocardial efficiency at rest in patients with HF. These effects are not associated with changes in myocardial perfusion or oxygen consumption. During dobutamine-induced stress, CRT does not affect functional parameters, but myocardial efficiency and metabolic reserve may be increased.

摘要

目的

评估长期心脏再同步治疗（CRT）对左心室（LV）能量代谢和代谢储备的影响。

背景

心脏再同步治疗是一种针对药物治疗无效的严重心力衰竭（HF）患者的新疗法。

方法

对10例特发性扩张型心肌病患者进行研究，这些患者在8±5个月前已植入双心室起搏器，研究分两种情况进行：CRT开启时，以及CRT关闭24小时后。使用超声心动图测量左心室功能，使用[（11）C]乙酸正电子发射断层扫描测量氧化代谢。两种测量均在静息状态和多巴酚丁胺诱发应激（5微克/千克/分钟）期间进行。使用[（15）O]水定量基础状态和腺苷刺激（140微克/千克/分钟）下的心肌血流量。

结果

在CRT关闭期间，静息时左心室每搏量显著降低（72±18毫升对63±15毫升，p<0.05），但左心室氧化代谢（K（单））保持不变（0.046±0.008对0.054±0.016分钟-1），导致心肌前向作功效率显著恶化（从48.2±16.7到36.6±11.7毫米汞柱·升/克，p<0.05）。在多巴酚丁胺诱发应激期间，无论CRT开启还是关闭，每搏量和K（单）值均无差异。然而，当CRT关闭时，心肌效率（56.1±16.1对49.8±18.0毫米汞柱·毫升·克-1·分钟-1，p = 0.099）和代谢储备，即K（单）对多巴酚丁胺的反应（0.023±0.014对0.013±0.014分钟-1，p = 0.09）有降低趋势。心脏再同步治疗对心肌灌注无影响。在CRT关闭期间利钠肽显著增加。