Unit:
ΠΜΣ Καρδιοαναπνευστική ΑναζωογόνησηLibrary of the School of Health Sciences
Author:
Saplaouras Athanasios
Supervisors info:
Κουσκούνη Ευαγγελία, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Τσεκούρα Δωροθέα, ΕΔΙΠ, Ιατρική, ΕΚΠΑ
Ιακωβίδου Νικολέττα, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Ανταπόκριση στη θεραπεία καρδιακού επανασυγχρονισμού σε ασθενείς με καρδιακή ανεπάρκεια που πληρούν τα κριτήρια Strauss
Translated title:
Cardiac resynchronization therapy response in heart failure patients with Strauss left bundle branch block
Summary:
Background: Cardiac resynchronization therapy (CRT) has proved to be effective in improving morbidity and mortality in patients suffering from severe congestive heart failure. Its efficacy has been shown to be greater in patients with left bundle branch block (LBBB). The aim of our study was to investigate whether the proposed LBBB criteria by Strauss identify patients with a better response to CRT.
Methods: We evaluated a group of 48 patients with symptomatic heart failure (ischemic or non-ischemic etiology), despite optimal drug therapy. The study inclusion criteria were LVEF ≤35% and the presence of LBBB with QRS ≥130 msec in the ECG prior to implantation. The patients under study were subjected to CRT-D implantation in our electrophysiology center from January 2013 until December 2017. Patients were divided into 2 groups depending on whether they presented Strauss LBBB or not.
Results: Of the 22 Strauss LBBB patients, 20 (90.9%) responded to CRT device therapy while the remaining 2 (9.1%) patients were non-responders (p <0.01). The non-responding group had a significantly higher risk of hospitalizations (p <0.01) and ventricular arrhythmias (p =0.03) during follow-up compared to responders. Interestingly, while the incidence of mortality during follow-up was low (0.04%), the 2 patients who died were non-responders to CRT therapy. At the end of follow-up, a significant increase in ejection fraction (18% increase) and a significant decrease in LVESV (74.1) were noticed in Strauss LBBB patients (p <0.001) while a significant but quiet lower increase in ejection fraction (5%) and decrease in LVESV (27,6) were noticed in non strauss group (p <0.001). Finally, in patients with dilated cardiomyopathy and Strauss LBBB, an improvement of the ejection fraction by 22% versus 6% in patients with conventional LBBB was observed (p <0.001).
Conclusion: The Strauss LBBB patients have better clinical and echocardiographic response than LBBB patients, particularly in those with dilated cardiomyopathy
Main subject category:
Health Sciences
Keywords:
LBBB, Strauss LBBB, CRT, CRT response
