Russian Heart Failure Journal 2013year Prognostic evaluation of biventricular pacing efficacy in patients with severe chronic heart failure


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2013/№2

Prognostic evaluation of biventricular pacing efficacy in patients with severe chronic heart failure

Lebedev D. I., Minin S. M., Krivolapov S. N.
Federal State Budgetary Institution, “Research Institute of Cardiology” at the Siberian Branch of Russian Academy of Medical Sciences, Kievskaya 111a, Tomsk 634012

Keywords: DCMP, radionuclide diagnostics, resynchronization therapy, atrial fibrillation, CHF

DOI: 10.18087 / rhfj.2013.2.1783

Background. The method of cardiac resynchronizing therapy (CRT) is a new, promising approach to the treatment of CHF. Aim. To identify the factors which influence the result of CRT and to analyze a possibility of using radionuclide methods to determine indications for administration of this invasive intervention. Materials and methods. The study included 64 patients with DCMP aged 32 to 75 years, III NYHA FC CHF, LV EF 30.1±3.8 %, 6min walk distance 290.5±64.3 m, and end-diastolic volume (EDV) 220.7±50.9 ml. All patients underwent 24h ECG monitoring before and one year after CRT. Patients were divided into groups based on their records of atrial fibrillation (AF). The first group included 40 (62.5 %) patients diagnosed with constant AF and the duration of arrhythmia history 1–3 years (mean, 2±1.2 years). The second group included 24 (37.5 %) patients with sinus rhythm (SR). Prior to CRT, 28 patients underwent gated radionuclide ventriculography (GRVG) including evaluation of LV EF increment. CRT devices featuring a defibrillator function were implanted to all patients and complete artificial AV block was created in patients with AF. Results. In one year, beneficial clinical changes were observed in all patients: LV EF increased to 42.8±4.8 % (p≤0.001); HF FC decreased from III to II; 6min walking distance increased to 377.2±45.3 m (p≤0.001); and LV EDP decreased to 197.9±47.8 ml (p≤0.005). Spontaneous recovery of SR was observed in 24 (37.5 %) during one year. In patients who had had SR before the study, the EF increment for one year was 14 % and average EDP decreased by 32 ml. In patients with constant AF, EF increased by 9 % and EDP decreased only by 13 ml for one year of CRT. In patients with AF at baseline and subsequent spontaneous SR recovery, the one-year EF increment was 13 % and EDP decreased by 18 ml on the average. At the second stage of study, the patients were divided into responders and non-responders based on the EF increment at 12 months of CRT and retrospective evaluation of myocardial metabolic defect (MMD) using GRVG. Responders were the patients who had MMD below 15 % before CRT whereas the patients with MMD higher than 15 % at baseline were non-responders. Conclusion. Therefore, recovery and maintenance of SR using CRT provides improvement of hemodynamic parameters and clinical condition in CHF patients with DCMP and AF. Preservation of fatty acid metabolism (LV EDP <15 %) is a predictor of CRT efficacy in patients with DCMP.
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Lebedev D. I., Minin S. M., Krivolapov S. N. Prognostic evaluation of biventricular pacing efficacy in patients with severe chronic heart failure. Russian Heart Failure Journal. 2013;14 (2):82-88

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