2012


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2012/№5

Algorithm of patient selection for the various variants of cardiac resynchronization therapy

Yakush N. A., Romanovskiy D. V., Kurlianskaia E. K., Ostrovskiy A. Yu., Koliadko M. G., Rachok L. V., Shumovets V. V., Kovalenko O. N., Sidorenko I. V., Shket A. P., Sevrukevich V. I., Dubovik T. A., Kudnitckaia V. S., Troianova T. A., Ostrovskiy Yu. P., Atroshchenko E. S., Mrochek A. G.

Keywords: biventricular electrostimulation, myocardial dyssinchrony, cardiomyopathy, end diastolic-volume, heart failure, cardiac resynchronization therapy

DOI: 10.18087/rhfj.2012.5.1704

Relevance. Cardiac resynchronization therapy (CRT) is an established therapy of severe CHF. However, lack of success of CRT in more than 30 % patients emphasizes necessity of improvement of the existing or search for new criteria for patient selection for CRT. Objective. Reveal factors influencing efficiency of biventricular pacing and concomitant administration epicardial biventricular pacing with surgical correction of atrioventricular failure. Materials and methods. 48 patients with CHF FC III–IV, EF ≤35 %, QRS ≥120 ms. Group 1 (n=21) included patients who underwent concomitant epicardial biventricular pacing with surgical correction of atrioventricular failure. Group 2 (n=27) included patients who underwent transvenous biventricular pacing. At baseline and in 12 months after surgery, ECG, EchoCG, Holter monitoring, common and biochemical blood tests, and brain natriuretic peptide test were carried out. Results. Quantitative criteria of patient selection with refractory CHF FC III–IV were identified. Predictors of positive hemodynamic response to the various variants of cardiac resynchronization therapy were set. Mitral failure grade <3 is a criterion of patient selection with refractory CHF FC III–IV for the various treatment. BNP level <1627 pg / ml for transvenous biventricular pacing and end-systolic LV volume <323 ml for concomitant epicardial biventricular pacing and surgical correction of atrioventricular failure are important predictors of the positive hemodynamic response. Indices of mechanical dyssinchrony of LV myocardium are markers of patient selection for CRT, but are not predictors of the positive hemodynamic response. Conclusion. CRT indications in patients with refractory CHF III–IV FC were specified.
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Yakush N. A., Romanovskiy D. V., Kurlianskaia E. K. et al. Algorithm of patient selection for the various variants of cardiac resynchronization therapy. Russian Heart Failure Journal. 2012;13(5):267-273

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