Mechanical Dyssynchrony Is Not Everything of Substrate but Is Essential for Cardiac Resynchronization Therapy Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Pro)

被引:5
作者
Kanzaki, Hideaki [1 ]
机构
[1] Natl Cerebral & Cardiovasc Ctr, Dept Cardiovasc Med, Heart Failure Div, Suita, Osaka 5658565, Japan
关键词
Cardiac resynchronization therapy; Dilated cardiomyopathy; Echocardiography; Heart failure; LEFT-VENTRICULAR DYSSYNCHRONY; HEART-FAILURE PATIENTS; TIME 3-DIMENSIONAL ECHOCARDIOGRAPHY; MYOCARDIAL CONTRACTILE RESERVE; OPTIMAL ATRIOVENTRICULAR DELAY; DOBUTAMINE STRESS-ECHO; CODED TISSUE DOPPLER; SPECKLE-TRACKING; MITRAL REGURGITATION; PROSPECT PREDICTORS;
D O I
10.1253/circj.CJ-10-1221
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Cardiac resynchronization therapy (CRT) improves heart failure symptoms, cardiac function and long-term prognosis. As a result, it has been established as a treatment for refractory heart failure by using a specialized pacemaker to restore coordinated ventricular contractions with pacing. Despite being an invasive treatment, however, the above effects are not observed in 30-45% of patients selected based on the standard criteria that includes New York Heart Association class Ill or IV heart failure, left ventricular ejection fraction <= 35%, and QRS duration >= 120 or 130 ms. From the fact that quantifiable resynchronization was associated with hemodynamic and clinical improvements, it should follow that mechanical dyssynchrony is a critical substrate for the benefits from CRT. The PROSPECT study unexpectedly demonstrated limitations of echocardiographic parameters using M-mode, pulsed-wave Doppler, and tissue Doppler imaging for accurately and reproducibly predicting response to CRT. However, advances in speckle tracking strain and real-time 3-D echocardiography have furthered the development of more sophisticated indices of dyssynchrony. Stress echocardiography might be useful for the detection of latent mechanical dyssynchrony in failing hearts. Because the substrate for CRT efficacy is multifactorial, a discriminant score that includes various clinical parameters and echocardiographic indices of mechanical dyssynchrony is needed to improve patient selection for CRT. (Circ J 2011; 75: 457-464)
引用
收藏
页码:457 / 464
页数:8
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