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Kardiyak resenkronizasyon tedavisinde ekokardiyografinin rolü

Year 2009, Volume: 31 Issue: 3, 316 - 330, 24.03.2009

Gökhan Bektaşoğlu , Mehmet Yılmaz , İzzet Tandoğan

Abstract

Özet

Randomize klinik çalışmalarda, orta ve ileri derecede kalp yetersizliğinin tedavisinde kardiyak resenkronizasyon tedavisinin (KRT) yararlı etkileri gösterilmiştir. Ancak KRT' ye verilen cevap kişiler arasında farklılıklar göstermektedir. Klinik takipte KRT uygulanan hastaların %30-50' sinde tedaviye yanıt gözlenememektedir. KRT den fayda görecek hastaları belirleyecek özgül tekniklere ihtiyaç duyulmaktadır. Bu teknikler içerisinden ekokardiyografi, son yıllarda, KRT implantasyonu öncesi mekanik dissenkroninin varolduğu hastaların belirlenebilmesi için tercih edilen yöntem olmuştur. Mekanik dissenkroniyi tespit edebilmesine rağmen, ekokardyografinin kullanımı yönünde tartışmalar halen devam etmektedir. Günümüzde hasta seçimi için rutin kullanımı önerilmemesine rağmen, önümüzdeki yıllarda KRT uygulanacak hastaların seçiminde ekokardiyografinin tercih edilecek yöntem olabileceği düşünülmektedir.

Anahtar sözcükler: Ekokardiyografi, kardiyak resenkronizasyon tedavisi, kalp yetersizliği, kardiyomiyopati, mekanik dissenkroni

 

Abstract

Numerous randomized clinical trials demonstrated the beneficial effects of cardiac resynchronization therapy (CRT) in the treatment of moderate to severe heart failure. However, response to CRT may vary significantly among individuals. 30-50 % of patients still do not respond to CRT in clinical practice. Specific techniques in order to determine the patients who will benefit from CRT are required. Among these techniques, echocardiography has emerged over recent years as the technique of choice to identify patients for the presence of mechanical dyssynchrony before CRT implantation. Despite its usefulness in detecting mechanical dyssynchrony, this issue is still a matter of debate. Although its routine use in patient selection is not recommended today, it seems echocardiography will be the method of choice in patient selection to CRT for the next years.

Keywords: Echocardiography, cardiac resynchronization therapy, heart failure, cardiomyopathy, mechanical dyssynchrony

Keywords

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References

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  • Iuliano S, Fisher SG, Karasik PE, Fletcher RD, Singh SN; Department of Veterans Affairs Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. QRS duration and mortality in patients with congestive heart failure. Am Heart J 2002; 143: 1085-91.
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  • Mortensen PT, Sogaard P, Mansour H, Ponsonaille J, Gras D, Lazarus A, Reiser W, Alonso C, Linde CM, Lunati M, Kramm B, Harrison EM. Sequential biventricular pacing: evaluation of safety and efficacy. Pacing Clin Electrophysiol 2004; 27: 339-45.
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Kardiyak resenkronizasyon tedavisinde ekokardiyografinin rolü

Year 2009, Volume: 31 Issue: 3, 316 - 330, 24.03.2009

Gökhan Bektaşoğlu , Mehmet Yılmaz , İzzet Tandoğan

Abstract

Randomize klinik çalışmalarda, orta ve ileri derecede kalp yetersizliğinin tedavisinde kardiyak resenkronizasyon tedavisinin (KRT) yararlı etkileri gösterilmiştir. Ancak KRT’ ye verilen cevap kişiler arasında farklılıklar göstermektedir. Klinik takipte KRT uygulanan hastaların %30-50’ sinde tedaviye yanıt gözlenememektedir. KRT den fayda görecek hastaları belirleyecek özgül tekniklere ihtiyaç duyulmaktadır. Bu teknikler içerisinden ekokardiyografi, son yıllarda, KRT implantasyonu öncesi mekanik dissenkroninin varolduğu hastaların belirlenebilmesi için tercih edilen yöntem olmuştur. Mekanik dissenkroniyi tespit edebilmesine rağmen, ekokardyografinin kullanımı yönünde tartışmalar halen devam etmektedir. Günümüzde hasta seçimi için rutin kullanımı önerilmemesine rağmen, önümüzdeki yıllarda KRT uygulanacak hastaların seçiminde ekokardiyografinin tercih edilecek yöntem olabileceği düşünülmektedir

Keywords

Ekokardiyografi kardiyak resenkronizasyon tedavisi kalp yetersizliği kardiyomiyopati mekanik dissenkroni

References

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  • Murkofsky RL, Dangas G, Diamond JA, Mehta D, Schaffer A, Ambrose JA. A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction. J Am Coll Cardiol 1998; 32: 476-82.
  • Hamby RI, Weissman RH, Prakash MN, Hoffman I. Left bundle branch block: a predictor of poor left ventricular function in coronary artery disease. Am Heart J 1983; 106: 471-7.
  • Iuliano S, Fisher SG, Karasik PE, Fletcher RD, Singh SN; Department of Veterans Affairs Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. QRS duration and mortality in patients with congestive heart failure. Am Heart J 2002; 143: 1085-91.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-49.
  • Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC; Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med
  • Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC. Long-term benefits of biventricular pacing in congestive heart failure: results from the Multisite Stimulation in Cardiomyopathy (MUSTIC) Study. J Am Coll Cardiol 2002; 40: 111-8.
  • Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J; MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845-53.
  • St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, Loh E, Kocovic DZ, Fisher WG, Ellestad M, Messenger J, Kruger K, Hilpisch KE, Hill MR; Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation 2003; 107: 1985-90.
  • Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schöndube F, Wolfhard U, Böcker D, Krahnefeld O, Kirkels H; Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group.Long-term clinical effect of hemodynamically optimised cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002; 39: 2026-33.
  • Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-50.
  • Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STImulation in Cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002; 40: 111-8.
  • Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol 2002; 39: 194-201.
  • Woo GW, Petersen-Stejskal S, Johnson JW, Conti JB, Aranda JA Jr, Curtis AB. Ventricular reverse remodeling and 6-month outcomes in patients receiving cardiac resynchronization therapy: analysis of the MIRACLE study. J Interv Card Electrophysiol 2005; 12: 107-13.
  • Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, van der Wall EE, Schalij MJ, Bax JJ. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006; 113: 969-76.
  • Ypenburg C, Schalij MJ, Bleeker GB, Steendijk P, Boersma E, Dibbets-Schneider P, Stokkel MP, van der Wall EE, Bax JJ. Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. Eur Heart J 2007; 28: 33-41.
  • Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M. Biventricular pacing in heart failure: back to basics in the pathophysiology of left bundle branch block to reduce the number of nonresponders. Am J Cardiol 2003; 91 (Suppl): 55F-61F.
  • Alonso C, Leclercq C, Victor F, Mansour H, de Place C, Pavin D, Carré F, Mabo P, Daubert JC. Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol 1999; 84 : 1417-21.
  • Sogaard P, Kim WY, Jensen HK, Mortensen P, Pedersen AK, Kristensen BØ, Egeblad H. Impact of acute biventricular pacing on left ventricular performance and volumes in patients with severe heart failure. A tissue Doppler and three-dimensional echocardiographic study. Cardiology 2001; 95: 173-82.
  • Nelson GS, Curry CW, Wyman BT, Kramer A, Declerck J, Talbot M, Douglas MR, Berger RD, McVeigh ER, Kass DA. Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation 2000; 101: 2703-9.
  • Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2003; 92: 341-4.
  • Bleeker GB, Holman ER, Steendijk P, Boersma E, van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006; 48: 2243-50.
  • Yu CM, Chan YS, Zhang Q, Yip GW, Chan CK, Kum LC, Wu L, Lee AP, Lam YY, Fung JW. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol 2006; 48: 2251-7.
  • Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, Guida P, Andriani A, Mastropasqua F, Rizzon P. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002; 40: 1615-22
  • Marcus G, Rose E, Viloria EM, Schafer J, De Marco T, Saxon LA, Foster E; VENTAK CHF/CONTAK-CD Biventricular Pacing Study Investigators. Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients undergoing cardiac resynchronization therapy. J Am Coll Cardiol 2005; 46: 2208-14.
  • Rouleau F, Merheb M, Geffroy S, Berthelot J, Chaleil D, Dupuis JM, Victor J, Geslin P. Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy. Pacing Clin Electrophysiol 2001; 24: 1500- 06.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-49.
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There are 59 citations in total.

Details

Primary Language English
Journal Section Reviews
Authors

Gökhan Bektaşoğlu

Mehmet Yılmaz

İzzet Tandoğan

Publication Date March 24, 2009
Published in Issue Year 2009Volume: 31 Issue: 3

Cite

AMA Bektaşoğlu G, Yılmaz M, Tandoğan İ. Kardiyak resenkronizasyon tedavisinde ekokardiyografinin rolü. CMJ. September 2009;31(3):316-330.