Abstract:Although the estimates from limited studies vary on the proportion of patients with heart failure who also have ventricular dyssynchrony as reflected by a prolonged QRS complex, often in the form of left bundle branch block, the number of such patients is large (27% to 53%) and it is certainly in excess of the rate for the general population. Among these patients, 10% to 15% are candidates for cardiac resynchronization therapy (CRT) via biventricular pacing. Accumulated evidence from randomized controlled stud… Show more
“…Prolonged ventricular dyssynchrony induced by long-term RVP is associated with deleterious LV remodeling, which are LV dilatation and LV asymmetrical hypertrophy ( 2 , 8 , 9 ). A recent small series study documented that CRT was effective in improving LV function in young patients with RVP induced cardiomyopathy ( 10 , 11 ).…”
Cardiac resynchronization therapy (CRT) has been proven its value in adult patients with congestive heart failure of low ejection fraction and wide QRS duration. Contrast to adult patients, CRT has been rarely applied for young patients. We report on a 9-yr-old boy with progressive left ventricular (LV) dilatation and dysfunction following chronic VVI pacemaker therapy for congenital complete atrioventricular block associated with maternal anti-SSA/Ro and SSB/La antibody. His LV dysfunction was improved after epicardially established CRT.
“…Prolonged ventricular dyssynchrony induced by long-term RVP is associated with deleterious LV remodeling, which are LV dilatation and LV asymmetrical hypertrophy ( 2 , 8 , 9 ). A recent small series study documented that CRT was effective in improving LV function in young patients with RVP induced cardiomyopathy ( 10 , 11 ).…”
Cardiac resynchronization therapy (CRT) has been proven its value in adult patients with congestive heart failure of low ejection fraction and wide QRS duration. Contrast to adult patients, CRT has been rarely applied for young patients. We report on a 9-yr-old boy with progressive left ventricular (LV) dilatation and dysfunction following chronic VVI pacemaker therapy for congenital complete atrioventricular block associated with maternal anti-SSA/Ro and SSB/La antibody. His LV dysfunction was improved after epicardially established CRT.
“…Hence, the correction of ventricular asynchrony is an attractive treatment goal, and the methods for evaluating ventricular asynchrony are of great interest for obtaining the prognosis and optimizing therapy for HF patients. 2)3) QRS prolongation usually indicates impaired propagation of the electrical input, and this is frequently associated with increased morbidity and mortality of HF patients. 4)5) However, the recent data has demonstrated that mechanical asynchrony is not necessarily related to electrical asynchrony.…”
Background and Objectives:Recent technical developments with high-resolution real-time 3-dimensional echocardiography (RT3DE) have facilitated the acquisition of high quality images and the analysis of segmental volumetime curves (VTCs). The purposes of this study were to assess left ventricular (LV) asynchrony with using the VTCs of 16 segments by RT3DE and to compare this with tissue Doppler imaging (TDI) as a clinical parameter. Subjects and Methods:Twenty-three heart failure (HF) patients (LVEF: 25±6%, age: 60±13 years) and 16 normal controls underwent TDI and RT3DE at baseline and 1-year. The standard deviation (SD 3) of the end systolic time to reach the minimal systolic volume for the 16 segments on VTCs was obtained by RT3DE. The standard deviation (SD 2) of the electromechanical coupling time for the 8 segments was measured using TDI. Results: SD 3 was markedly higher in the HF patients than that in the controls (7.7±2.5 vs 1.5±1.0%, respectively, p< 0.01) and it increased as the LVEF decreased (r=-0.85, p<0.01). SD 2 was also significantly higher in the HF patients (27.0±8.6 vs 12.6±5.0 msec, respectively, p<0.01) and it had good negative correlation with the LVEF (r=-0.72, p<0.01). SD 3 was well correlated with SD 2 (r=0.66, p<0.01). At 1-year, the HF patients with an increased LVEF showed a decreased SD 3 (7/13). In contrast, the patients with a decreased LVEF had an increased SD 3 (3/13). Conclusion:The analysis of VTCs for the 16 LV segments with using RT3DE from a single acoustic window may be a useful clinical parameter for evaluating the LV function, including LV asynchrony, the LV volume and the LVEF. (Korean Circulation J 2006;36:669-675) KEY WORDS:Heart failure;Echocardiography.
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