Faculty of Medicine
Library of the School of Health Sciences

2020-10-15

2020

Poulidakis Emmanouil

Σταυρούλα Κουλοχέρη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Κωνσταντίνα Αγγέλη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Χριστόδουλος Στεφανάδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεράσιμος Σιάσος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Βλαχόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Τούτουζας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Πρόβλεψη ανταπόκρισης στη θεραπεία καρδιακού επανασυγχρονισμού με υπερηχογραφικά κριτήρια σε ασθενείς με καρδιακή ανεπάρκεια

Greek

Prediction of response to cardiac resynchronization therapy with echocardiographic criteria in patients with heart failure

Background: Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of echocardiography in identifying CRT responders or late responders using dyssynchrony parameters and the implementation of stress echocardiography.

Methods: 106 symptomatic heart failure patients were examined before, 6 months and 2–4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed-wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment.

Results: At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under the curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775), and presence of either ApR or SF (AUC = 0.772). The predictive ability of ApR and of ICR is augmented if late responders are also included. The performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability.

Conclusion: Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making in difficult clinical cases.

Health Sciences

Cardiac resynchronization therapy, Dyssynchrony, Stress echocardiography, Heart failure

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https://pergamos.lib.uoa.gr/uoa/dl/object/2924898