The effects of ventricular asynchrony on myocardial perfusion

被引:15
作者
Kyriakides, Zenon S.
Manolis, Athanase G.
Kolettis, Theofilos M.
机构
[1] Red Cross Hosp, Cardiol Dept 2, Athens 11526, Greece
[2] Univ Ioannina, Dept Cardiol, GR-45110 Ioannina, Greece
关键词
asynchrony; myocardial perfusion; coronary blood flow; cardiac efficiency;
D O I
10.1016/j.ijcard.2006.03.091
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Asynchronous depolarization and contraction sequence, secondary to intraventricular conduction defects or to permanent right ventricular apical pacing, is associated with adverse effects that may be clinically evident in the failing heart. Experimental and clinical studies have suggested that asynchronous ventricular contraction deteriorates left ventricular performance and induces unfavourable left ventricular remodelling. Although such contraction does not appear to affect resting coronary artery blood flow, it increases endomyocardial pressure during diastole and decreases regional myocardial perfusion in the interventricular septum. The magnitude of these effects may correlate with the duration of the asynchrony. Despite these detrimental effects, there is no evidence that ventricular asynchrony reduces collateral myocardial blood flow, myocardial oxygen consumption or cardiac efficiency, neither in patients with normal coronary arteries, nor in patients with coronary artery disease. Furthermore, in patients with acute ischaemic syndromes, ventricular asynchrony exerts a neutral effect on the ischaemic myocardium. Cardiac resynchronization therapy improves left ventricular systolic and diastolic function without an increase in myocardial oxygen consumption or energy cost. This therapy may decrease the inhomogeneity in regional oxidative metabolism, myocardial perfusion and cardiac efficiency. Further experimental and clinical studies are needed on this area. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:3 / 9
页数:7
相关论文
共 54 条
[1]   MYOFIBRILLAR DISARRAY PRODUCED IN NORMAL HEARTS BY CHRONIC ELECTRICAL PACING [J].
ADOMIAN, GE ;
BEAZELL, J .
AMERICAN HEART JOURNAL, 1986, 112 (01) :79-83
[2]   MODULATION OF THE ARTERIAL CORONARY BLOOD-FLOW BY ASYNCHRONOUS ACTIVATION WITH VENTRICULAR PACING [J].
AMITZUR, G ;
MANOR, D ;
PRESSMAN, A ;
ADAM, D ;
HAMMERMAN, H ;
SHOFTI, R ;
BEYAR, R ;
SIDEMAN, S .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1995, 18 (04) :697-710
[3]   Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay [J].
Auricchio, A ;
Stellbrink, C ;
Sack, S ;
Block, M ;
Vogt, J ;
Bakker, P ;
Huth, C ;
Schöndube, F ;
Wolfhard, U ;
Böcker, D ;
Krahnefeld, O ;
Kirkels, H .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (12) :2026-2033
[4]   Myocardial oxygen consumption and perfusion before and after cardiac resynchronization therapy: experimental observations and clinical implications [J].
Baller, D ;
Vogt, J ;
Lindner, O ;
Lamp, B ;
Holzinger, J ;
Kammeier, A ;
Wielepp, P ;
Burchert, W ;
Horstkotte, D .
EUROPEAN HEART JOURNAL SUPPLEMENTS, 2004, 6 (0D) :D91-D97
[5]   INCREASE OF MYOCARDIAL OXYGEN-CONSUMPTION DUE TO ACTIVE DIASTOLIC WALL TENSION [J].
BALLER, D ;
WOLPERS, HG ;
HOEFT, A ;
KORB, H ;
ROSICK, A ;
HELLIGE, G ;
BRETSCHNEIDER, HJ .
BASIC RESEARCH IN CARDIOLOGY, 1984, 79 (02) :176-185
[6]   UNFAVORABLE EFFECTS OF VENTRICULAR PACING ON MYOCARDIAL ENERGETICS [J].
BALLER, D ;
WOLPERS, HG ;
ZIPFEL, J ;
HOEFT, A ;
HELLIGE, G .
BASIC RESEARCH IN CARDIOLOGY, 1981, 76 (02) :115-123
[7]   BASIC PHYSIOLOGICAL-STUDIES ON CARDIAC PACING WITH SPECIAL REFERENCE TO THE OPTIMAL-MODE AND RATE AFTER CARDIAC-SURGERY [J].
BALLER, D ;
HOEFT, A ;
KORB, H ;
WOLPERS, HG ;
ZIPFEL, J ;
HELLIGE, G .
THORACIC AND CARDIOVASCULAR SURGEON, 1981, 29 (03) :168-173
[8]   COMPARISON OF THE EFFECTS OF RIGHT ATRIAL, RIGHT VENTRICULAR APEX AND ATRIOVENTRICULAR SEQUENTIAL PACING ON MYOCARDIAL OXYGEN-CONSUMPTION AND CARDIAC EFFICIENCY - A LABORATORY INVESTIGATION [J].
BALLER, D ;
WOLPERS, HG ;
ZIPFEL, J ;
BRETSCHNEIDER, HJ ;
HELLIGE, G .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1988, 11 (04) :394-403
[9]   BENIGN LEFT BUNDLE BRANCH BLOCK [J].
BEACH, TB ;
GRACEY, JG ;
PETER, RH ;
GRUNENWALD, PW .
ANNALS OF INTERNAL MEDICINE, 1969, 70 (02) :269-+
[10]   ACUTE EFFECTS OF DOBUTAMINE ON MYOCARDIAL OXYGEN-CONSUMPTION AND CARDIAC EFFICIENCY MEASURED USING C-11 ACETATE KINETICS IN PATIENTS WITH DILATED CARDIOMYOPATHY [J].
BEANLANDS, RSB ;
BACH, DS ;
RAYLMAN, R ;
ARMSTRONG, WF ;
WILSON, V ;
MONTIETH, M ;
MOORE, CK ;
BATES, E ;
SCHWAIGER, M .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (05) :1389-1398