Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay
Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay
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DOI：
10.1016/s0735-1097(02)01895-8
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发表时间：
2002-06-19
影响因子：
24
通讯作者：
Kirkels, H
中科院分区：
文献类型：
--
作者：
Auricchio, A;Stellbrink, C;Kirkels, H
我们试图比较一个（单心室）或两个心室（双心室）的心房同步预激的短期和长期临床效果，这提供了心脏起搏治疗（CRT）。CRT的临床效益仍在调查中。方法41例患者随机分为4周的第一次治疗与双心室或单心室刺激，随后4周没有治疗，然后4周的第二次治疗与相反的刺激。最佳CRT刺激持续9个月。通过植入时的血流动力学测试优化心脏起搏治疗。主要终点是运动能力测量。结果36例患者均选择左心室进行单心室起搏。单室和双室CRT的临床效果无显著差异。汇总每种方法的结果，以评估序贯治疗效应。在无氧阈下，自行车运动中的摄氧量从9.48 ml/kg/min增加到10.4 ml/kg/min（p = 0.03），峰值运动时从12.5至14/3 ml/kg/min（p < 0.001）第一次治疗，无氧阈值时为10.0 - 10.7 ml/kg/min（p = 0.2），运动峰值时为13.4 - 15.2 ml/kg/min（p = 0.002）。6分钟步行距离从基线时的342 in增加到第一次治疗后的386 m（p < 0.001）和第二次治疗后的416 In（p = 0.03）。所有的改善持续12个月后therapeutic.CONCLUSIONS心脏起搏治疗产生了长期的改善HF患者的临床症状有心室传导延迟。对于短期治疗，优化的双心室和单心室治疗之间的差异似乎很小。
OBJECTIVES We sought to compare the short- and long-term clinical effects of atrial synchronous pre-excitation of one (univentricular) or both ventricles (biventricular), that provide cardiac resynchronization therapy (CRT).BACKGROUND In patients with heart failure (HF) who have a ventricular conduction delay, CRT improves systolic hemodynamic function. The clinical benefit of CRT is still being investigated.METHODS Forty-one patients were randomized to four weeks of first treatment with biventricular or univentricular stimulation, followed by four weeks without treatment, and then four weeks of a second treatment with the opposite stimulation. The best CRT stimulation was continued for nine months. Cardiac resynchronization therapy was optimized by hemodynamic testing at implantation. The primary end points were exercise capacity measures. Data were analyzed by two-way repeated-measures analysis of variance.RESULTS The left ventricle was selected for univentricular pacing in 36 patients. The clinical effects of univentricular and biventricular CRT were not significantly different. The results of each method were pooled to assess sequential treatment effects. Oxygen uptake during bicycle exercise increased from 9.48 to 10.4 ml/kg/min at the anaerobic threshold (p = 0.03) and from 12.5 to 14/3 ml/kg/min at peak exercise (p < 0.001) with the first treatment, and from 10.0 to 10.7 ml/kg/min at the anaerobic threshold (p = 0.2) and from 13.4 to 15.2 ml/kg/mm at peak exercise (p = 0.002) with the second treatment. The 6-min walk distance increased from 342 in at baseline to 386 m after the first treatment (p < 0.001) and to 416 In after the second treatment (p = 0.03). All improvements persisted after 12 months of therapy.CONCLUSIONS Cardiac resynchronization therapy produces a long-term improvement in the clinical symptoms of patients with HF who have a ventricular conduction delay. The differences between optimized biventricular and univentricular therapy appear to be small for short-term treatment.