序贯双心室起搏心脏再同步治疗：超声心动图引导下VV间期优化对急性结果的影响

Cardiac resynchronization therapy with sequential biventricular pacing: impact of echocardiography guided VV delay optimization on acute results.

作者信息

Parreira Leonor, Santos José Ferreira, Madeira João, Mendes Lígia, Seixo Filipe, Caetano Filomena, Lopes Cláudia, Venãncio José, Mateus Arminda, Inês J Lopes, Mendes Miguel

机构信息

Serviço de Cardiologia, Hospital de São Bernardo, Setúbal, Portugal.

出版信息

Rev Port Cardiol. 2005 Nov;24(11):1355-65.

PMID:16463985

Abstract

BACKGROUND

Cardiac resynchronization therapy (CRT) improves left ventricular synchrony as evaluated by tissue Doppler imaging (TDI), leading to improved left ventricular performance and reverse remodeling. New CRT devices enable programming of left and right VV delay. The aim of this study was to determine whether sequential biventricular (BiV) pacing by echo-guided programming of VV delay would enhance the response to CRT.

METHODS

15 consecutive patients with severe heart failure and left bundle branch block underwent CRT by BiV device implantation. They were studied with conventional and TDI echo the day before implantation. Left ventricular ejection fraction (LVEF) was determined, and the electromechanical delay (QS), defined as the time interval from the beginning of the QRS to the S wave in pulsed TDI, was assessed in each of the four left ventricular basal segments. The dyssynchrony index was calculated as the difference between the longest and shortest electromechanical delay (QS(max-min)). The parameters were re-evaluated the day after implantation during simultaneous BiV pacing and with seven different VV delays. The optimal VV delay was determined by finding the VV interval corresponding to the maximum aortic velocity time interval (VTI).

RESULTS

QS(max-min) decreased from 85.3 +/- 27.0 msec to 46.7 +/- 23.0 msec (p = 0.0002), LVEF increased from 21.7 +/- 7.3% to 30.0 +/- 7.7% (p = 0.0001) and aortic VTI increased from 12.7 +/- 3.6 cm to 15.2 +/- 4.0 cm (p < 0.0001), with simultaneous BiV pacing. The VV intervals were programmed as follows: LV pre-excitation by 10 msec in five patients, 20 msec in three, 30 msec in two, and 40 msec in three; and RV pre-excitation by 10 msec in one and by 20 msec in one. The maximal aortic VTI obtained with VV delay programming increased from 15.2 +/- 4.0 cm to 17.7 +/- 4.0 cm (p = 0.0005). During optimized sequential BiV pacing, QS(max-min) further decreased from 46.7 +/- 23.0 msec to 30.6 +/- 21.0 msec (p = 0.02) and LVEF further increased from 30.0 +/- 7.7% to 35.0 +/- 7.7% (p = 0.0003).

CONCLUSIONS

Sequential BiV pacing with VV delay optimized by evaluation of aortic VTI enhanced the response to CRT with additional improvements in left ventricular synchrony and left ventricular function compared to simultaneous CRT.

摘要

背景

心脏再同步治疗（CRT）可改善左心室同步性，这通过组织多普勒成像（TDI）评估得出，进而改善左心室功能并实现逆向重构。新型CRT设备能够对左右心室间延迟（VV延迟）进行程控。本研究的目的是确定通过超声引导下程控VV延迟进行序贯双心室（BiV）起搏是否会增强对CRT的反应。

方法

15例连续的重度心力衰竭且伴有左束支传导阻滞的患者接受了BiV设备植入的CRT治疗。在植入前一天对他们进行了常规超声心动图和TDI超声心动图检查。测定左心室射血分数（LVEF），并在左心室四个基底节段中的每一个节段评估机电延迟（QS），QS定义为脉冲TDI中从QRS波起始至S波的时间间隔。不同步指数计算为最长与最短机电延迟（QS（max - min））之间的差值。在植入后一天，在同时进行BiV起搏且设置七种不同VV延迟的情况下对这些参数进行重新评估。通过找到与最大主动脉速度时间间隔（VTI）对应的VV间期来确定最佳VV延迟。

结果

在同时进行BiV起搏时，QS（max - min）从85.3±27.0毫秒降至46.7±23.0毫秒（p = 0.0002），LVEF从21.7±7.3%增至30.0±7.7%（p = 0.0001），主动脉VTI从12.7±3.6厘米增至15.2±4.0厘米（p < 0.0001）。VV间期程控如下：5例患者左心室预激10毫秒，3例20毫秒，2例30毫秒，3例40毫秒；1例患者右心室预激10毫秒，1例20毫秒。通过VV延迟程控获得的最大主动脉VTI从15.2±4.0厘米增至17.7±4.0厘米（p = 0.0005）。在优化的序贯BiV起搏期间，QS（max - min）进一步从46.7±23.0毫秒降至30.6±21.0毫秒（p = 0.02），LVEF进一步从30.0±7.7%增至35.0±7.7%（p = 0.0003）。