Nazeri Alireza, Massumi Ali, Rasekh Abdi, Saeed Mohammad, Frank Christopher, Wilson J Michael, Lopez J Alberto, Razavi Mehdi
Department of Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, 6624 Fannin, Suite 2480, Houston, TX, USA.
Europace. 2009 Jan;11(1):86-8. doi: 10.1093/europace/eun326. Epub 2008 Dec 4.
Cardiac resynchronization therapy (CRT) has reportedly not been effective in the absence of electrical or mechanical dyssynchrony. We present six patients with severe left ventricular (LV) dilation, mitral regurgitation (MR), and non-ischaemic cardiomyopathy who underwent CRT. We assessed the effects of CRT on LV ejection fraction (EF), LV dimensions, mitral valve regurgitant fraction (RF), pulmonary arterial pressures (PAP), and serum levels of B-natriuretic peptide (BNP).
All patients had severe LV dilation (>/=6.8 cm) and no electrical or mechanical dyssynchrony. All patients underwent CRT-D (with defibrillator) without complications. Average echocardiographic follow-up was 4.6 months. Mean LVEF increased significantly from 20.8 +/- 3.4 to 28.3 +/- 2.9% after CRT (P < 0.01). Mean LV end-diastolic dimension decreased significantly from 6.9 +/- 0.15 to 6.45 +/- 0.33 cm after CRT (P = 0.03); mean BNP serum level decreased from 1738 +/- 526 to 1040 +/- 768 pg/mL (P = 0.07). Baseline RF decreased from 45 +/- 12.2 to 20 +/- 10.9% after CRT-D (P = 0.009). Mean PAP decreased from 48.5 +/- 5.8 to 42.6 +/- 5.2 (P = 0.03). In five patients, New York Heart Association class symptoms improved by at least one level. No patients required assist devices or transplantation. One patient was hospitalized during follow-up.
We describe six patients with severe LV dilation without evidence of electrical or mechanical dyssynchrony who improved with CRT, possibly due to improvement in MR.
据报道，在不存在电或机械不同步的情况下，心脏再同步治疗（CRT）无效。我们报告了6例患有严重左心室（LV）扩张、二尖瓣反流（MR）和非缺血性心肌病的患者接受了CRT治疗。我们评估了CRT对左心室射血分数（EF）、左心室尺寸、二尖瓣反流分数（RF）、肺动脉压（PAP）和B型利钠肽（BNP）血清水平的影响。
所有患者均有严重的左心室扩张（≥6.8 cm），且无电或机械不同步。所有患者均接受了CRT-D（带除颤器）治疗，无并发症发生。平均超声心动图随访时间为4.6个月。CRT治疗后，平均左心室射血分数从20.8±3.4显著增加至28.3±2.9%（P<0.01）。CRT治疗后，平均左心室舒张末期内径从6.9±0.15显著减小至6.45±0.33 cm（P = 0.03）；平均BNP血清水平从1738±526降至1040±768 pg/mL（P = 0.07）。CRT-D治疗后，基线反流分数从45±12.2降至20±10.9%（P = 0.009）。平均肺动脉压从48.5±5.8降至42.6±5.2（P = 0.03）。5例患者的纽约心脏协会心功能分级症状改善至少一级。无患者需要辅助装置或进行移植。1例患者在随访期间住院。
我们描述了6例严重左心室扩张且无电或机械不同步证据的患者，他们通过CRT治疗得到改善，可能是由于二尖瓣反流得到改善。
