A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Cardiac resynchronization therapy - Part 1 - Issues before device implantation
Tekijät: Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JWH, Garrigue S, Gorcsan J, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, Yu CM
Kustantaja: ELSEVIER SCIENCE INC
Julkaisuvuosi: 2005
Journal: Journal of the American College of Cardiology
Tietokannassa oleva lehden nimi: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Lehden akronyymi: J AM COLL CARDIOL
Vuosikerta: 46
Numero: 12
Aloitussivu: 2153
Lopetussivu: 2167
Sivujen määrä: 15
ISSN: 0735-1097
DOI: https://doi.org/10.1016/j.jacc.2005.09.019
Tiivistelmä
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction < 35%, and wide QRS complex (> 120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echo cardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction < 35%, and wide QRS complex (> 120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echo cardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
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