Edner Magnus, Ring Margareta, Särev Tooomas
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
Cardiovasc Ultrasound. 2010 Apr 12;8:12. doi: 10.1186/1476-7120-8-12.
Biventricular pacing (BiP) is an effective treatment in systolic heart failure (HF) patients with prolonged QRS. However, approximately 35% of the patients receiving BiP are classified as non-responders. The aim of this study is to evaluate the acute effects of VV-optimization on systolic heart function.
Twenty-one HF patients aged 72 (46-88) years, QRS 154 (120-190) ms, were studied with echocardiography, Tissue Doppler Imaging (TDI) and 3D-echo the first day after receiving a BiP device. TDI was performed; during simultaneous pacing (LV-lead pacing 4 ms before the RV-lead) and during sequential pacing (LV 20 and 40 ms before RV and RV 20 and 40 ms before LV-lead pacing). Systolic heart function was studied by tissue tracking (TT) for longitudinal function and systolic maximal velocity (SMV) for regional contractility and signs of dyssynchrony assessed by time-delays standard deviation of aortic valve opening to SMV, AVO-SMV/SD and tissue synchronization imaging (TSI).
The TT mean value preoperatively was 4.2 +/- 1.5 and increased at simultaneous pacing to 5.0 +/- 1.2 mm (p < 0.05), and at best VV-interval to 5.4 +/- 1.2 (p < 0.001). Simultaneous pacing achieved better TT distance compared with preoperative in 16 patients (76%). However, it was still higher after VV-optimization in 12 patients 57%. Corresponding figures for SMV were 3.0 +/- 0.7, 3.5 +/- 0.8 (p < 0,01), and 3.6 +/- 0.8 (p < 0.001). Also dyssynchrony improved.
VV-optimization in the acute phase improves systolic heart function more than simultaneous BiP pacing. Long-term effects should be evaluated in prospective randomized trials.
双心室起搏（BiP）是治疗QRS波增宽的收缩性心力衰竭（HF）患者的一种有效方法。然而，接受BiP治疗的患者中约有35%被归类为无反应者。本研究的目的是评估VV间期优化对收缩期心脏功能的急性影响。
对21例年龄72（46 - 88）岁、QRS波时限154（120 - 190）ms的HF患者，在植入BiP设备后的第一天，采用超声心动图、组织多普勒成像（TDI）和三维超声心动图进行研究。进行TDI检查；在同步起搏期间（左心室电极起搏比右心室电极提前4 ms）和序贯起搏期间（左心室电极分别比右心室电极提前20和40 ms起搏，右心室电极分别比左心室电极提前20和40 ms起搏）。通过组织追踪（TT）评估纵向功能的收缩期心脏功能，通过收缩期最大速度（SMV）评估局部收缩性，并通过主动脉瓣开放至SMV的时间延迟标准差（AVO - SMV/SD）和组织同步成像（TSI）评估不同步征象。
术前TT平均值为4.2±1.5，同步起搏时增加至5.0±1.2 mm（p < 0.05），最佳VV间期时增加至5.4±1.2（p < 0.001）。与术前相比，16例患者（76%）同步起搏时TT距离更好。然而，在12例患者（57%）中，VV间期优化后TT距离仍更高。SMV的相应数值分别为3.0±0.7、3.5±0.8（p < 0.01）和3.6±0.8（p < 0.001）。不同步情况也有所改善。
急性期的VV间期优化比同步BiP起搏更能改善收缩期心脏功能。长期影响应在前瞻性随机试验中进行评估。
