Sequential biventricular pacing improves regional contractility, longitudinal function and dyssynchrony in patients with heart failure and prolonged QRSReportar como inadecuado




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Cardiovascular Ultrasound

, 8:12

First Online: 12 April 2010Received: 03 February 2010Accepted: 12 April 2010

Abstract

AimsBiventricular pacing BiP is an effective treatment in systolic heart failure HF patients with prolonged QRS.
However, approximately 35% of the patients receiving BiP are classified as non-responders.
The aim of this study is to evaluate the acute effects of VV-optimization on systolic heart function.

MethodsTwenty-one HF patients aged 72 46-88 years, QRS 154 120-190 ms, were studied with echocardiography, Tissue Doppler Imaging TDI and 3D-echo the first day after receiving a BiP device.
TDI was performed; during simultaneous pacing LV-lead pacing 4 ms before the RV-lead and during sequential pacing LV 20 and 40 ms before RV and RV 20 and 40 ms before LV-lead pacing.
Systolic heart function was studied by tissue tracking TT for longitudinal function and systolic maximal velocity SMV for regional contractility and signs of dyssynchrony assessed by time-delays standard deviation of aortic valve opening to SMV, AVO-SMV-SD and tissue synchronization imaging TSI.

ResultsThe TT mean value preoperatively was 4,2 ± 1,5 and increased at simultaneous pacing to 5,0 ± 1,2 mm p < 0,05, and at best VV-interval to 5,4 ± 1,2 p < 0,001.
Simultaneous pacing achieved better TT distance compared with preoperative in 16 patients 76%.
However, it was still higher after VV-optimization in 12 patients 57%.
Corresponding figures for SMV were 3,0 ± 0,7, 3,5 ± 0,8 p < 0,01, and 3,6 ± 0,8 p < 0,001.
Also dyssynchrony improved.

ConclusionsVV-optimization in the acute phase improves systolic heart function more than simultaneous BiP pacing.
Long-term effects should be evaluated in prospective randomized trials.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-7120-8-12 contains supplementary material, which is available to authorized users.

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Autor: Magnus Edner - Margareta Ring - Tooomas Särev

Fuente: https://link.springer.com/article/10.1186/1476-7120-8-12



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