Hardt Stefan E, Yazdi Said Hashem Fani, Bauer Alexander, Filusch Arthur, Korosoglou Grigorios, Hansen Alexander, Bekeredjian Raffi, Ehlermann Philipp, Remppis Andrew, Katus Hugo A, Kuecherer Helmut F
Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Int J Cardiol. 2007 Feb 14;115(3):318-25. doi: 10.1016/j.ijcard.2006.03.015. Epub 2006 Aug 7.
Acute changes of the AV-delay in CRT patients have a significant impact on hemodynamics. However, the chronic functional effects of AV-delay optimization have not been systematically examined despite of their potential role for chronic functional improvement.
Therefore, in this study we investigated whether optimization of AV-delay in CRT patients as assessed by echocardiographic measurement of the velocity time integral of the left ventricular outflow tract (LVOT-VTI) chronically changes (1) echocardiographic parameters of systolic and diastolic left ventricular function, (2) walking distance in the 6-min walk test, (3) levels of NT-proBNP and (4) quality of life as assessed by a standard questionnaire. 33 patients underwent optimization of AV-delay 31+/-8 weeks after initiation of CRT. Follow up (FU) was conducted 43+/-5 days later.
E/Ea, the ratio of peak E-wave of mitral inflow and of TDI of the mitral annulus, significantly decreased immediately post-optimization (11+/-1 vs. 14+/-1 at baseline, p<0.05) and further decreased at FU (8+/-1, p<0.05 vs. immediately post-optimization) indicating improvement of diastolic function, while traditional parameters of diastolic function derived from pulse wave Doppler remained unchanged. There was a slight increase of LV-ejection fraction as assessed by echocardiography acutely after optimization (baseline: 25+/-2%, optimized: 28+/-1%, p<0.05), while LV-ejection fraction at FU did not differ from baseline. 6-min walk test improved from 449+/-17 m (baseline) to 475+/-17 m at FU (p<0.05). During this period NT-proBNP significantly decreased from 3193+/-765 ng/l to 2593+/-675 ng/l (p<0.05). Quality of life was unchanged at FU.
This study demonstrates for the first time chronic functional improvement due to AV-delay optimization in patients with CRT.
心脏再同步治疗（CRT）患者房室延迟的急性变化对血流动力学有重大影响。然而，尽管房室延迟优化对慢性功能改善具有潜在作用，但其慢性功能影响尚未得到系统研究。
因此，在本研究中，我们调查了通过超声心动图测量左心室流出道速度时间积分（LVOT-VTI）评估的CRT患者房室延迟优化是否会长期改变：（1）左心室收缩和舒张功能的超声心动图参数；（2）6分钟步行试验中的步行距离；（3）NT-proBNP水平；（4）通过标准问卷评估的生活质量。33例患者在开始CRT后31±8周进行房室延迟优化。43±5天后进行随访（FU）。
二尖瓣流入峰值E波与二尖瓣环组织多普勒成像（TDI）的E/A比值（E/Ea）在优化后立即显著降低（基线时为14±1，优化后为11±1，p<0.05），在随访时进一步降低（8±1，与优化后相比p<0.05），表明舒张功能改善，而脉冲波多普勒得出的传统舒张功能参数保持不变。优化后急性超声心动图评估的左心室射血分数略有增加（基线：25±2%，优化后：28±1%，p<0.05），而随访时的左心室射血分数与基线无差异。6分钟步行试验从基线时的449±17米改善到随访时的475±17米（p<0.05）。在此期间，NT-proBNP从3193±765纳克/升显著降至2593±675纳克/升（p<0.05）。随访时生活质量未改变。
本研究首次证明CRT患者因房室延迟优化而出现慢性功能改善。
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