Download presentation
Presentation is loading. Please wait.
Published byLoraine Porter Modified over 9 years ago
1
La selezione dei pazienti candidati alla Terapia Resincronizzante Cardiaca M Cristina Porciani Firenze “Incontri Pitagorici di Cardiologia 2010” “Πυθαγόρειοι κάνουμε συναντήσεις καρδιολογίας” VIIIa Edizione
2
It has been well established that CRT is able to improve clinical and hemodinamic parameters in patients with heart failure and LBBB
3
McAlister FA et al, Ann Intern Med. 2004;. CRT reduces HF hospitalizations
4
McAlister FA et al, Ann Intern Med. 2004;. CRT improves quality of life
5
Cleland JGF et al NEJM 2005 CRT reduces mortality
6
CRT reverses LV remodeling t Sutton MG Circulation 2003
7
Reverse remodeling induced by CRT Baseline 3 months 6months CRT
8
1 Circulation 2002 Biventricular Stimulation in Patients With Medically Refractory Heart Failure NYHA III- IV, Idiopathic or Ischemic Cardiomyopathy, QRS 120 ms, and EF 35% Guidelines of ACC/AHA (2009)
9
RATIONALE OF CRT LBBB discordinate contraction ventricular dysfunction
10
Electrical asinchrony Mechanical asynchrony
11
Lecoq G et al Eur Heart J 2005 Reduction of QRS duration occurs only in responders
12
% Ghio S et al Eur Heart J 2004;25:571-578
13
Echocardiographic Data Before and After Cardiac Resynchronization Therapy Achilli A et al JACC 2003 QRS > 120ms QRS< 120ms
14
Leclerq C et al Circulation 2002 Electrical epicardial activation map of whole heart for 3 pacing modes Mechanical Resynchronization Does Not Require Electrical Synchrony in the Dilated Failing Heart With Left Bundle-Branch Block
15
Leclerq C et al Circulation 2002 Mechanical LV activation map of whole heart for 3 pacing modes Mechanical Resynchronization Does Not Require Electrical Synchrony in the Dilated Failing Heart With Left Bundle-Branch Block
16
it appears that Mechanical rather than electrical synchrony seems most important for functional improvement with CRT
17
Interventricular asynchrony
19
TDI is useful in recording the chronology and the entity of the velocity curves of miocardium segments
20
Ts-SD Cut-off 33ms the Standard Deviation of the 6 basal and the 6 mid LV segmental Ts as systolic asynchrony parameter Ts
21
septal to lateral delay cut-off 60 ms Bax et al. AM J Cardiol 2003;92:1238-40
22
Yu et al. JACC 2005; 45:677-84. TSI (Tissue Synchronization Imaging)
23
No single measure of mechanical dyssynchrony may be recommended to improve pt selection forCRT Methodology to determine mechanical dyssynchrony needs further elaboration QRS remains the selection criterium of dyssynchrony to identify for CRT Circulation 2008 Results of the PROSPECT study
24
From the initial focus on electrical markers, recent interest has shifted toward a more direct assessment of mechanical dyssynchrony by means of tissue Doppler imaging (TDI). From the initial focus on electrical markers, recent interest has shifted toward a more direct assessment of mechanical dyssynchrony by means of tissue Doppler imaging (TDI). from the direct assessment of mechanical dyssynchrony, attention again shifted toward QRS From the initial focus on electrical markers, interest shifted toward a more direct assessment of mechanical dyssynchrony by means of tissue Doppler imaging (TDI).
25
Porciani et al Echocardiography 2010 Electrical asynchrony + - + Mechanical asynchrony - + +
26
Porciani et al Echocardiography 2010
27
Since it is electrical activation that produces myocardial contraction that in turn is necessary for cardiac movement, why would they be any different? The question is
28
► Problems with measuring electrical ayncrony ► Electromechanical interaction ► Complex nature of electrical and mechanical aynchrony The answer should be
29
Problems with measuring electrical synchrony Xiao Br Heart J 1994 Signal averaged electrocardiography detects potentials too low to appear on the standard 12 lead electrocardiogram
30
Di Donato et al Circulation 2004 Surgical Ventricular Restoration Improves Mechanical Intraventricular Dyssynchrony in Ischemic Cardiomyopathy Narrow QRS
31
Di Donato et al Circulation 2004 Surgical Ventricular Restoration Improves Mechanical Intraventricular Dyssynchrony in Ischemic Cardiomyopathy Narrow QRS
32
Tournoux F. JCE, 2007 Concordance Between Mechanical and Electrical Dyssynchrony in Heart Failure Patients: A Function of the Underlying Cardiomyopathy?
33
What’s about mechanichal dyssynchrony? Henein MY Heart 1999
34
Longitudinal asynchrony (TDI) Radial asynchrony (Speckle-tracking radial strain) Gorcsan J. JACC 2007 Combined Longitudinal and Radial Dyssynchrony Predicts Ventricular Response After Resynchronization Therapy
35
) Gorcsan J. JACC 2007
36
Porciani et al PACE 2008
37
RV ejectionRV filling LV ejectionLV filling RV ejectionRV filling LV ejection LV filling IVCTIVRT IVCTIVRT Normal LBBB
38
a – b R-R Total isovolumic Time Index
39
Myocardial Performance Index (MPI)
40
Porciani et al J Card Med 2010
43
CONCLUSIONS Which is the best?
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.