Effects of cardiac resynchronization therapy in patients with advanced congestive heart failure evaluated by real-time 3-dimensional echocardiography
10.3760/cma.j.issn.0253-3758.2013.08.009
- VernacularTitle:实时三维超声心动图可评价并预测心脏再同步化治疗的疗效
- Author:
Yong-Hui ZHAO
1
;
Jia-Ying ZHANG
;
Chang-Hua WEI
;
Xian-Qing WANG
;
Jing ZHANG
;
Yu XU
;
Chuan-Yu GAO
Author Information
1. 河南省人民医院心内科
- Keywords:
Heart failure,congestive;
Pacemaker,artificial;
Echocardiography
- From:
Chinese Journal of Cardiology
2013;41(8):668-673
- CountryChina
- Language:Chinese
-
Abstract:
Objective To quantitatively assess the effects of cardiac resynchronization therapy (CRT) in patients with advanced congestive heart failure by real-time 3-dimensional(3D) echocardiography (RT-3DE).Methods Eighteen patients with advanced congestive heart failure underwent CRT with New York Heart association(NYHA) class Ⅲ and Ⅳ and wide QRS complex(＞ 120 ms) were included (17 dilated cardiomyopathy and 1 ischemic cardiomyopathy).Before CRT and 8 months after CRT,the clinical and RT-3DE parameters and outcome were analyzed.Results The biventricular pacemaker was successfully implanted in 17 patients (94.4％).Compared with before CRT,NYHA class of patients decreased by 1.5 class (P ＜ 0.01),left ventricular ejection fraction increased by 25％ (P ＜ 0.01),left ventricular end systolic volume decreased by 38％ (P ＜ 0.01),left ventricular systolic dyssynchrony index (SDI) improved significantly (14.2％ before CRT vs.9.8％ after CRT,P ＜0.01) post CRT.Change in SDI and change in LVEF was positively correlated (r =0.62,P ＜ 0.01).The procedure complications and outcome during and after CRT included coronary sinus dissection (n =1),left ventricular lead dislodgement (n =1),phrenic nerve stimulation (n =1),sudden cardiac death (n =1).Three non-response patients were complicated with atrial fibrillation,nonspecific intraventricular block and diated cardiomyopathy with postero-lateral scar tissue.Conclusions CRT could improve the cardiac function,correct the mechanical desynchronization and reverse left ventricular remodeling in patients with congestive heart failure,and SDI quantification by RT-3DE could predict increase of LVEF after CRT,however,there were complications related to the implantation procedure and possibilities of non-response.
