在心脏再同步治疗患者中，多点左心室起搏可改善通过压力-容积环评估的急性血流动力学反应。
Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients.
作者信息
Pappone Carlo, Ćalović Žarko, Vicedomini Gabriele, Cuko Amarild, McSpadden Luke C, Ryu Kyungmoo, Romano Enrico, Saviano Massimo, Baldi Mario, Pappone Alessia, Ciaccio Cristiano, Giannelli Luigi, Ionescu Bogdan, Petretta Andrea, Vitale Raffaele, Fundaliotis Angelica, Tavazzi Luigi, Santinelli Vincenzo
机构信息
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
出版信息
Heart Rhythm. 2014 Mar;11(3):394-401. doi: 10.1016/j.hrthm.2013.11.023. Epub 2013 Nov 28.
BACKGROUND
Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics.
OBJECTIVE
To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients.
METHODS
Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention.
RESULTS
Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing -dP/dtmin (-13.5% ± 10.2% vs -10.6% ± 6.8%; P = .011), relaxation time constant (-7.5% ± 9.0% vs -4.8% ± 7.2%; P = .012), and end-diastolic pressure (-18.2% ± 22.4% vs -8.7% ± 21.4%; P < .001) as compared with the best CONV intervention.
CONCLUSIONS
CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.
背景
传统心脏再同步治疗（CRT）可改善急性心脏血流动力学。
目的
研究在单个冠状静脉窦分支中采用多点左心室（LV）起搏的CRT（多点起搏[MPP]，圣犹达医疗公司，加利福尼亚州西尔玛）能否为患者带来更多血流动力学益处。
方法
44例连续接受CRT设备植入（圣犹达医疗公司的Unify Quadra MP或Quadra Assura MP以及Quartet LV导线）的患者（80%为男性，纽约心脏协会心功能Ⅲ级，收缩末期容积180±77 mL，射血分数27%±6%，QRS时限152±17 ms），通过压力-容积环系统（Inca，CD Leycom）在术中评估LV血流动力学。执行了一项起搏方案，包括9次双心室起搏干预，其中使用远端和近端LV电极进行传统CRT（CONV）以及各种MPP配置。每次起搏干预以随机顺序进行两次，每次干预后重复右心室起搏（基线）。
结果
42例患者获得了可评估记录。相对于基线，与最佳CONV干预相比，最佳MPP干预显著提高了压力变化率（dP/dtmax；15.9%±10.0%对13.5%±8.8%；P<.001）、每搏功（27.2%±42.5%对19.4%±32.2%；P=.018）、每搏量（10.4%±22.5%对4.1%±13.1%；P=.003）和射血分数（10.5%±20.9%对5.3%±13.2%；P=.003）。此外，与最佳CONV干预相比，最佳MPP干预改善了急性舒张功能，显著降低了-dP/dtmin（-13.5%±10.2%对-10.6%±6.8%；P=.011）、舒张时间常数（-7.5%±9.0%对-4.8%±7.2%；P=.012）和舒张末期压力（-18.2%±22.4%对-8.7%±21.4%；P<.001）。
结论
与CONV相比，采用MPP的CRT可通过压力-容积环测量显著改善评估的急性LV血流动力学参数。
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