优化心脏再同步治疗患者房室及室间延迟的潜在获益。

Potential benefit of optimizing atrioventricular & interventricular delays in patients with cardiac resynchronization therapy.

机构信息

Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.

Department of Cardiology, Medical University of Lodz, Lodz, Poland.

出版信息

Indian J Med Res. 2017 Jul;146(1):71-77. doi: 10.4103/ijmr.IJMR_1560_14.

DOI:10.4103/ijmr.IJMR_1560_14

PMID:29168462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5719610/

Abstract

BACKGROUND & OBJECTIVES: The clinical benefit of optimization (OPT) of atrioventricular delay (AVD) and interventricular delay (VVD) in cardiac resynchronization therapy (CRT) remains debatable. This study was aimed to determine the influence of AVD and VVD OPT on selected parameters in patients early after CRT implantation and at mid-term follow up (FU).

METHODS

Fifty two patients (61±10 yr, 23 males) with left bundle branch block, left ventricular ejection fraction (LVEF) ≤35 per cent and heart failure were selected for CRT implantation. Early on the second day (2DFU) after CRT implantation, the patients were assigned to the OPT or the factory setting (FS) group. Haemodynamic and electrical parameters were evaluated at baseline, on 2DFU after CRT and mid-term FU [three-month FU (3MFU)]. Echocardiographic measures were assessed before implantation and at 3MFU. The AVD/VVD was deemed optimal for the highest cardiac output (CO) with impedance cardiography (ICG) monitoring.

RESULTS

On 2DFU, the AVD was shorter in the OPT group, LV was paced earlier than in FS group and CO was insignificantly higher in OPT group. At 3MFU, improvement of CO was observed only in OPT patients, but the intergroup difference was not significant. At 3MFU in OPT group, reduction of LV in terms of LV end-diastolic diameter (LVeDD), LV end-systolic diameter, LV end-diastolic and systolic volume with the improvement in LVEF was observed. In FS group, only a reduction in LVeDD was present. In OPT group, the paced QRS duration was shorter than in FS group patients.

INTERPRETATION & CONCLUSIONS: CRT OPT of AVD and VVD with ICG was associated with a higher CO and better reverse LV remodelling. CO monitoring with ICG is a simple, non-invasive tool to optimize CRT devices.

摘要

背景与目的

心脏再同步治疗（CRT）中房室（AV）和室间（VV）延迟的优化（OPT）对临床获益仍存在争议。本研究旨在观察 CRT 术后早期和中期随访（FU）时 AV 与 VV 优化对患者的影响。

方法

选择 52 名（61±10 岁，男 23 例）左束支传导阻滞、左室射血分数（LVEF）≤35%、心力衰竭的患者行 CRT 植入术。术后第 2 天（2DFU）将患者随机分为 OPT 组或工厂设置（FS）组。在基线、CRT 术后 2DFU 和中期 FU[3 个月 FU（3MFU）]时评估血流动力学和电参数。在植入前和 3MFU 时评估超声心动图指标。通过阻抗心动图（ICG）监测确定获得最高心输出量（CO）的最佳 AV 和 VV 延迟。

结果

2DFU 时，OPT 组的 AV 更短，LV 起搏更早，CO 稍高，但无统计学差异。3MFU 时，仅 OPT 组的 CO 改善，组间差异无统计学意义。3MFU 时，与 FS 组相比，OPT 组 LV 缩小，LV 舒张末期直径（LVeDD）、LV 收缩末期直径、LV 舒张末期和收缩末期容积减少，LVEF 改善。FS 组仅 LVeDD 减少。OPT 组的 QRS 时限短于 FS 组。