Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy.


  • 影响因子：1.25
  • DOI：10.1159/000503953
  • 作者列表："Algazzar AS","Elbably MM","Katta AA","Elmeligy N","Elrabbat K","Qutub MA
  • 发表时间：2020-01-01

BACKGROUND:The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. OBJECTIVES:This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. METHODS:We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. RESULTS:After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. CONCLUSION:RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.


背景: 心脏再同步化治疗 (CRT) 背后的想法是起搏两个心室，导致左心室 (LV) 的同步电-机械耦合，这意味着应该尽一切努力提高CRT应答者的百分比。 目的: 本研究旨在证明右心室心尖 (RVA) 和中间隔 (RVS) 导联位置联合不同LV导联位置对LV心肌应变、不同步和临床结果的短期影响。 方法: 我们检查了60例植入前和植入6个月后有CRT指征的患者的临床结果和CRT反应 (6分钟步行试验 [6MWT]，NYHA分级，左心室收缩末期容积 [LVESV] 减少> 15%)，不同步和心肌应变。 结果: 随访6个月后，与基线值相比，两种RV导联位置代表6MWT、左心室射血分数和LVESV的显著改善，但两组之间没有发现显著差异。关于NYHA分级改善，在基线和植入后6个月，两组之间的p值 (0.44和0.88) 分别不显著。在基线时，RVA组的平均6MWT为273.8 m，而RVS组为279.0 m (p = 0.84)。CRT植入6个月后，RVA组6MWT平均值为326.5 m，而RVS组为316.2 m (p = 0.74)。心脏后外侧静脉部位与RVS位置联合使用时，在室间隔和室室内不同步、整体纵向应变、整体圆周应变和心尖圆周应变方面显示出显著改善 (分别为p = 0.01 0.032、0.02、0.005和0.049)。 结论: RVS并不劣于RVA起搏，在短期随访中提供了一种良好的替代RVA起搏的方法。然而，QRS时限、心肌应变和不同步取决于RV和LV刺激部位。根据冠状静脉窦LV导联位置的长期发病率和死亡率结果需要更多的评估。





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