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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.
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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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