Echocardiography parameter for evaluation of various effects of cardiac resynchronization therapy

Ilov, N. N.; Stompel, D. R.; Palnikova, O. V.; Нечепуренко, А. А.

doi:10.17116/kardio20221501119

Cited by 2 publications

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“…Нами было установлено, что увеличение ФВ ЛЖ даже на ≥5% в ходе проведения СРТ следует рассматривать в качестве важного предиктора модификации аритмического риска. Сформулированные выводы соответствуют ранее опубликованным данным, полученным на меньшей когорте больных c ХСН [7]. ФВ ЛЖ, не являясь показателем сократительной способности, отражает только изменение объемов ЛЖ.…”

Section: Discussionunclassified

“…В большинстве исследований наличие ответа на СРТ определяется по уменьшению конечного систолического объема (КСО) ЛЖ либо увеличению фракции выброса (ФВ) ЛЖ. Согласно ранее полученным на сравнительно небольшой когорте больных c ХСН собственным результатам, уменьшение КСО ЛЖ на ≥15% ассоциируется со снижением 2-летней сердечно-сосудистой летальности, в то время как прирост ФВ ЛЖ на ≥5% чувствителен к модификации аритмического риска [7].…”

Section: статистический анализunclassified

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Cardiac resynchronization therapy: potential for arrhythmic risk modification

Ilov

Boytsov

Нечепуренко

2023

Cardiovasc Ther Prev

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Aim. To evaluate the impact of cardiac resynchronization therapy (CRT) on the risk of sustained ventricular tachyarrhythmias (VT) in patients with heart failure (HF) with a implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death.Material and methods. This single-center prospective clinical study included 470 patients (men, 84%) with HF at the age of 57 (51-62) years with a left ventricular ejection fraction (LVEF) of 29 (25-33)%. There were following exclusion criteria: indications for cardiac surgery, known channelopathies, previously registered VT. Depending on intraventricular conduction disorders, dual-chamber ICDs (42%) or CRT-D (58%) were implanted. After ICD implantation, patients were followed up for 24 months to register the end point — a first-time sustained paroxysm of VT detected by the ICD. A positive response to CRT was established in the case of an increase in LVEF by ≥5% of the initial level.Results. A total of 388 patients underwent full postoperative follow-up. The studied arrhythmic endpoint occurred on average 21 (0,6) months after implantation in 104 patients (27%) with higher frequency in the ICD group. However, the differences in the VT rate in the study groups were statistically unreliable (30% in the ICD group versus 24% in the CRT-D group, p=0,142). It was found that the VT rate was reliably lower in CRT-responders (118 patients, 53%): 15% compared to 32% in the group of inefficient CRT. A 5% increase in the LFEF reduced the probability of VT occurrence by 3 times (odds ratio [OR]=0,34; 95% of CI: 0,13-0,86; p=002). Significant modification of arrhythmic risk was verified by increasing LFEF to 36-40% (OR=0,72; 95% CI: 0,63-0,82; p=0,04).Conclusion. The results obtained indicate that effective CRT has the potential to modify arrhythmic risk in patients with HF, especially with an increase in LVEF to the level of 36-40%.

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Cardiac resynchronization therapy: potential for arrhythmic risk modification

Ilov

Boytsov

Нечепуренко

2023

Cardiovasc Ther Prev

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Factors Associated with a Positive Hemodynamic Response to Cardiac Resynchronization Therapy

Нечепуренко

Ilov

Zorin

et al. 2022

Cardiac Arrhythmias

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AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT. MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 34 CHF with a left ventricular ejection fraction of 35%, QRS duration of 150 ms, QRS duration of 130149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by 15%. RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint. CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.

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Echocardiography parameter for evaluation of various effects of cardiac resynchronization therapy

Cited by 2 publications

References 20 publications

Cardiac resynchronization therapy: potential for arrhythmic risk modification

Cardiac resynchronization therapy: potential for arrhythmic risk modification

Factors Associated with a Positive Hemodynamic Response to Cardiac Resynchronization Therapy

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