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2006, vol. 134, br. 11-12, str. 488-491
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Ehokardiografska procena resinhronizacione terapije miokarda
Echocardiographic evaluation of cardiac resynchronization therapy
Klinički centar Srbije, Klinika za kardiologiju, Beograd, Srbija
e-adresa: drmilanpet@ptt.yu
Sažetak
Uvod: Resinhronizaciona terapija miokarda (CRT) je relativno nov metod u lečenju insuficijencije rada srca, naročito kod dilatacione kardiomiopatije (DCM) sa blokom leve grane (LBBB). Cilj rada: Cilj rada je bio da se procene uspeh resinhronizacione terapije miokarda u lečenju teške insuficijencije srca i značaj ehokardiografije u oceni rezultata takvog lečenja. Metod rada Ispitivanu grupu je činilo 19 bolesnika (13 muškaraca i šest žena), prosečne starosti od 58,0±8,22 godine (raspon: 47-65 godina), koji su lečeni resinhronizacionom terapijom zbog dilatacione kardiomiopatije i teške insuficijencije rada srca (NYHA III-IV) sa blokom leve grane i ejekcionom frakcijom (EF) manjom od 35%. Bolesnici su u proseku nadgledani 17 meseci (raspon: 6,5-30 meseci). Standardni kolor dopler (Color Doppler) ehokardiografski pregled urađen je kod svih ispitanika pre i nekoliko puta posle CRT. Posmatrani su parametri sistolne i dijastolne funkcije leve komore, mitralna insuficijencija i pritisak u desnoj komori. Rezultati Posle CRT utvrđeno je statistički značajno poboljšanje endsistolne dimenzije leve komore, minutnog volumena, indeksa rada srca, indeksa udarnog volumena, indeksa sposobnosti kontrakcije miokarda (myocardial performance index) (p<0,01) i udarnog volumena (p<0,05). Srednja vrednost ejekcione frakcije leve komore povećala se za 10%, a frakcioniranog skraćenja leve komore za 6% kod deset bolesnika (62%). CRT je doveo do smanjenja mitralne insuficijencije (p<0,01), produženja vremena dijastolnog punjenja leve komore (p<0,02) i pada sistolnog pritiska u desnoj komori (p<0,05). Asinhronija između leve i desne komore smanjena je za 28% (18 ms). Zaključak CRT ima važnu ulogu u poboljšanju funkcije leve komore i korekciji ventrikularne asinhronije. Ehokardiografija je koristan metod u proceni rezultata lečenja hronične insuficijencije rada srca resinhronizacijom miokarda.
Abstract
Introduction: Cardiac resynchronization therapy (CRT) is relatively new tool in treatment of chronic heart failure (HF), especially in dilated cardiomyopathy (DCM) with the left bundle branch block (LBBB). Objective: The Objective of our study was to assess the success of CRT in treatment of severe HF and the role of echocardiography in the evaluation of Results of such therapy. Method: The group consisted of 19 patients, 13 males and 6 females, mean age 58.0±8.22 years (47-65 years) with CRT applied for DCM, severe HF (NYHA III-IV), LBBB and ejection fraction (EF) <35%. The mean follow up was 17 months (6.5-30). Standard color Doppler echocardiography examination was performed in all patients before and after CRT. The parameters of systolic and diastolic left ventricular function, mitral insufficiency and the right ventricular pressure were evaluated. Results: Following the CRT, statistically significant improvement of the end-systolic LV dimension, cardiac output, cardiac index, myocardial performance index (p<0.01) and stroke index (p<0.05) was recorded. The mean value of EFLV was increased by 10% and LV fractional shortening improved by 6% in 10/16 (62%) patients. CRT resulted in decreased MR (p<0.01), prolonged LV diastolic filling time (p<0.02) and reduced RV pressure (p<0.05). Interventricular mechanical delay was shortened by 28% (18 msec) Conclusion: CRT has an important role in improvement of LV function and correction of ventricular asynchrony. The echocardiography is a useful tool for evaluation of HF treatment with CRT.
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