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CARDIAC RESYNCHRONIZATION THERAPY IN CHRONIC HEART FAILURE WITH ATRIAL FIBRILLATION: ANALYSIS AND RESULT PREDICTION

Aim. To develop a multifactor response prediction model to CRT in patients with CHF complicated by AF taking into consideration myocardium dyssinchrony parameters, clinical, functional, and laboratory predictors of a positive response to interventional treatment. Methods. The article is devoted to the evaluation of cardiac resynchroniza- tion therapy (CRT) clinical results in patients with chronic heart failure (CHF) and persistent atrial fibrillation (AF) within 12 months after interventional treatment. The paper presents multifactor CRT response prediction models taking into consideration electrical and mechanical myocardium dyssinchrony parameters, as well as clinical, functional, and laboratory positive response predictors. Results. CRT results in patients with CHF complicated by AF showed variable patterns dependent on time and persistence of the treatment outcome: long-term outcome retention in a three-month period (39%); “escape” from CRT early outcome (9%); delayed echocardiographic response to CRT (in 12 months); no response to CRT (21%). Early response to CRT predictor complex (during the first 3 months) in patients with CHF and AF mainly includes myocardial dyssinchrony parameters (QR complex width, presystolic aortic valve delay, pulmonary artery valve delay, interventricular delay, dyssinchrony index), as well as CHF severity criteria (CHF FC, NT-proBNP concentration) and myocardial deformity in the apical projection. The most significant contribution to the prediction of the long-term effectiveness of CRT in patients with CHF and AF is made by parameters reflecting the severity of interventricular and intraventricular cardiac dyssinchrony: presystolic delay on the aortic valve and dispersion of intraventricular contraction. Additional prognostic criteria for the CRT response are lower values of myocardial deformity in the apical projection and GFR. Conclusion. The linear model developed to assess the dynamics of LV ESV allows individualizing the patient selection for interventional treatment in case of predicting an unstable early response to CRT.