2015


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2015/№2

The use of different methods for selection of patients with non-ischemic cardiomyopathy for cardiac resynchronization therapy

Lebedev D. I., Zlobina M. V., Minin S. M., Sokolov A. A., Savenkova G. M., Krivolapov S. N., Popov S. V.
Federal State Budgetary Institution, "Research Institute of Cardiology" at the Siberian Branch of Russian Academy of Medical Sciences, Kievskaya 111a, Tomsk 63402

Keywords: cardiomyopathy, treatment, resynchronization therapy, CHF

DOI: 10.18087/rhfj.2015.2.2046

Background. The method of cardiac resynchronization therapy (CRT) is one of new, promising methods for treatment of CHF. Development of new methods for selection of candidates for CRT is an important task in the treatment of CHF. Aim. To use different methods for selection of patients for CRT and to evaluate a possibility for using these methods in clinical practice to increase the treatment efficacy. Materials and methods. The study included 88 patients with decompensated myocardiopathy (DCMP) aged 32 to 75 with NYHA FC III CHF, LV EF 30.1±3.8 %, 6‑min walk test distance 290.5±643 m, LV end diastolic volume (EDV) 220.7±50.9 ml, and intra- and interventricular dyssynchrony >120 msec. At the stage of selection, the patients were divided into three groups. In the first group (n=28), myocardial metabolism defect (MMD) was evaluated using radionuclide methods; in the second group (n=24), tricuspid annular systolic velocity (SRV) was evaluated; the third group (n=36) was the control. Results. The follow-up examination was performed in one year. 69 (78.5 %) patients were clinical CRT responders; 19 (21.5 %) patients did not respond to CRT. The first group contained 3 (10.7 %) non-responders; the second group contained 6 (25 %) non-responders, and the third group contained 10 (27.7 %) non-responders. In the first group, there were 25 (89.3 %) responder patients who had had MMD <15 % prior to CRT; when MMD was >15 %, the patients were non-responders. In the second group, there were 18 (75 %) responder patients who had had SRV >10 cm / sec (mean, 12.5±2.1 cm / sec, (р=0.0001)) prior to CRT. Conclusion. Preserved myocardial metabolism (LV MMD <15 %) is a predictor of effective CRT in patients with DCMP. SRV is an independent predictor for a response to SRT and allows identifying CRT responders at the stage of selection with sensitivity of 85 % and specificity of 83 %. Complex use of all described methods is warranted at the stage of selecting patients for CRT, which will improve the treatment efficacy.
  1. Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J. 2001 Sep;22 (17):1527–60.
  2. Bleasdale RA, Frenneaux MP. Cardiac resynchronization therapy: when the drugs don’t work. Heart. 2004 Dec;90 (Suppl 6):vi2–4.
  3. Thom T, Haase N, Rosamond W et al. Heart disease and stroke statistics-2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006 Feb 14;113 (6):e85–151.
  4. Leckercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002 Jan 16;39 (2):194–201.
  5. Bax JJ, Abraham T, Barold SS et al. Cardiac resynchronization thera­py. Part 2 – issues during and after device implantation and unresolved questions. J Am Coll Cardiol. 2005 Dec 20;46 (12):2168–82.
  6. Соколов А. А., Марцинкевич Г. И. Электромеханический асинхронизм сердца и сердечная недостаточность. Кардиология. 2005;45 (5):85–91.
  7. Попов С. В., Савенкова Г. М., Антонченко И. В. и др. Эффекты кардиоресинхронизирующей терапии в лечении застойной сердечной недостаточности. Сибирский медицинский журнал (г. Томск). 2010;25 (2–1):25–33.
  8. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation. 2003 Nov 25;108 (21):2596–603.
  9. Рабочая группа по электрокардиостимуляции и сердечной ресинхронизирующей терапии ЕОК. Рекомендации по электрокардио­стимуляции и сердечной ресинхронизирующей терапии. ESC 2013. Российский кардиологический журнал. 2014;4 (108):5–63.
  10. Hesse B, Tägil K, Cuocolo A et al. EANM / ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005 Jul;32 (7):855–97.
  11. Mangiavacchi M, Gasparini M, Faletra F et al. Clinical predictors of marked improvement in left ventricular performance after cardiac resynchronization therapy in patients with chronic heart failure. Am Heart J. 2006 Feb;151 (2):477.e1–477.e6.
  12. Cleland JG, Daubert JC, Erdmann E et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005Apr 14;352 (15):1539–49.
  13. Abraham WT, Fisher WG, Smith AL et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002 Jun 13;346 (24):1845–53.
  14. Bristow MR, Saxon LA, Boehmer J et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004 May 20;350 (21):2140–50.
  15. Burri H, Sunthorn H, Somsen A et al. Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy. Europace. 2008 Mar;10 (3):374–8.
  16. Abraham WT, Fisher WG, Smith AL et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002 Jun 13;346 (24):1845–53.
  17. Bax JJ, Ansalone G, Breithart OA et al. Echocardiographic evaluation of cardiac resynchronizalion therapy: ready for routine clinical use? A critical appraisal. J Am Coll Cardiol. 2004 Jul 7;44 (1):1–9.
  18. van Bommel RJ, Bax JJ, Abraham WT et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J. 2009 Oct;30 (20):2470–7.
  19. Yu CM, Fung LW, Zhang Q et al. Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation. 2004 Jul 6;110 (1):66–73.
  20. Notabartolo D, Merlino JD, Smith AL et al. Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy. Am J Cardiol. 2004 Sep 15;94 (6):817–20.
  21. Pitzalis MV, Iacoviello M, Romito R et al. Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy. J Am Coll Cardiol. 2005 Jan 4;45 (1):65–9.
  22. Lecoq G, Leclercq C, Leray E et al. Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure. Eur Heart J. 2005 Jun;26 (11):1094–100.
  23. Molhoek SG, Van Erven L, Bootsma M et al. QRS duration and shortening to predict clinical response to cardiac resynchronization therapy in patients with end-stage heart failure. Pacing Clin Electrophysiol. 2004 Mar;27 (3):308–13.
  24. Konstam MA, Rousseau MF, Kronenberg MW et al. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators. Circulation. 1992 Aug;86 (2):431–8.
  25. Kitaizumi K, Yukiiri K, Masugata H et al. Positron emission tomographic demonstration of myocardial oxidative metabolism in a case of left ventricular restoration after cardiac resynchronization therapy. Circ J. 2008 Nov;72 (11):1900–3.
  26. Гуля М. О., Лишманов Ю. Б., Завадовский К. В., Лебедев Д. И. Состояние метаболизма жирных кислот в миокарде левого желудочка и прогноз эффективности кардиоресинхронизирующей терапии у пациентов с дилатационной кардиомиопатией. Российский кардиологический журнал. 2014;9 (113):61–7.
  27. Лебедев Д. И., Минин С. М., Криволапов С. Н. Прогностическая оценка эффективности бивентрикулярной стимуляции у пациентов с тяжелой сердечной недостаточностью. Журнал Сердечная Недостаточность. 2013;14 (2):82–8.
  28. Chung ES, Leon AR, Tavazzi L et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation. 2008 May 20;117 (20):2608–16.
  29. Linde C, Ellenbogen K, McAlister FA. Cardiac resynchronization therapy (CRT): clinical trials, guidelines, and target populations. Heart Rhythm. 2012 Aug;9 (8 Suppl): S3‑S13.
  30. Bernard A, Donal E, Leclercq C et al. Impact of right ventricular contractility on left ventricular dyssynchrony in patients with chronic systolic heart failure. Int J Cardiol. 2011 May 5;148 (3):289–94.
  31. Злобина М. В., Соколов А. А., Попов С. В. Диагностическое значение постурального теста при отборе пациентов для сердечной ресинхронизирующей терапии. Вестник аритмологии. 2012;68:45–9.
  32. Santamore WP, Lynch PR, Heckman JL et al. Left ventricular effects on right ventricular developed pressure. J Appl Physiol. 1976 Dec;41 (6):925–30.
  33. Злобина М. В., Соколов А. А., Попов С. В. и др. Сохранность систолической функции правого желудочка – важный предиктор ответа на сердечную ресинхронизирующую терапию. Фундаментальные исследования. 2013;12–2:214–7.
Lebedev D. I., Zlobina M. V., Minin S. M. et al. The use of different methods for selection of patients with non-ischemic cardiomyopathy for cardiac resynchronization therapy. Russian Heart Failure Journal. 2015;16 (2):81–87

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