Antoniou Christos-Konstantinos, Manolakou Panagiota, Magkas Nikolaos, Konstantinou Konstantinos, Chrysohoou Christina, Dilaveris Polychronis, Gatzoulis Konstantinos A, Tousoulis Dimitrios
First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece.
Eur Cardiol. 2019 Apr;14(1):33-44. doi: 10.15420/ecr.2019.2.2.
Cardiac resynchronisation therapy is a cornerstone in the treatment of advanced dyssynchronous heart failure. However, despite its widespread clinical application, precise mechanisms through which it exerts its beneficial effects remain elusive. Several studies have pointed to a metabolic component suggesting that, both in concert with alterations in chamber mechanics and independently of them, resynchronisation reverses detrimental changes to cellular metabolism, increasing energy efficiency and metabolic reserve. These actions could partially account for the existence of responders that improve functionally but not echocardiographically. This article will attempt to summarise key components of cardiomyocyte metabolism in health and heart failure, with a focus on the dyssynchronous variant. Both chamber mechanics-related and -unrelated pathways of resynchronisation effects on bioenergetics - stemming from the ultramicroscopic level - and a possible common underlying mechanism relating mechanosensing to metabolism through the cytoskeleton will be presented. Improved insights regarding the cellular and molecular effects of resynchronisation on bioenergetics will promote our understanding of non-response, optimal device programming and lead to better patient care.
心脏再同步治疗是晚期不同步心力衰竭治疗的基石。然而，尽管其在临床广泛应用，但其发挥有益作用的确切机制仍不清楚。多项研究指出了一个代谢因素，表明再同步治疗与心室力学改变协同作用并独立于这些改变之外，可逆转细胞代谢的有害变化，提高能量效率和代谢储备。这些作用可能部分解释了功能改善但超声心动图未改善的反应者的存在。本文将试图总结健康和心力衰竭状态下心肌细胞代谢的关键组成部分，重点关注不同步型心力衰竭。将介绍再同步治疗对生物能量学产生影响的与心室力学相关和不相关的途径——源自超微观层面——以及一种可能的共同潜在机制，即通过细胞骨架将机械感受与代谢联系起来。对再同步治疗对生物能量学的细胞和分子效应的深入了解将增进我们对无反应情况、优化设备程控的理解，并带来更好的患者护理。
