Mechanical Dyssynchrony Is Not Everything of Substrate but Is Essential for Cardiac Resynchronization Therapy - Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Pro) -

• Kanzaki Hideaki

  Department of Cardiovascular Medicine, Heart Failure Division, National Cerebral and Cardiovascular Center

書誌事項

タイトル別名

• – Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Pro) –

抄録

Cardiac resynchronization therapy (CRT) improves heart failure symptoms, cardiac function and long-term prognosis. As a result, it has been established as a treatment for refractory heart failure by using a specialized pacemaker to restore coordinated ventricular contractions with pacing. Despite being an invasive treatment, however, the above effects are not observed in 30-45% of patients selected based on the standard criteria that includes New York Heart Association class III or IV heart failure, left ventricular ejection fraction ≤35%, and QRS duration ≥120 or 130ms. From the fact that quantifiable resynchronization was associated with hemodynamic and clinical improvements, it should follow that mechanical dyssynchrony is a critical substrate for the benefits from CRT. The PROSPECT study unexpectedly demonstrated limitations of echocardiographic parameters using M-mode, pulsed-wave Doppler, and tissue Doppler imaging for accurately and reproducibly predicting response to CRT. However, advances in speckle tracking strain and real-time 3-D echocardiography have furthered the development of more sophisticated indices of dyssynchrony. Stress echocardiography might be useful for the detection of latent mechanical dyssynchrony in failing hearts. Because the substrate for CRT efficacy is multifactorial, a discriminant score that includes various clinical parameters and echocardiographic indices of mechanical dyssynchrony is needed to improve patient selection for CRT. (Circ J 2011; 75: 457-464)<br>

収録刊行物

• Circulation Journal

  Circulation Journal 75 (2), 457-464, 2011

  一般社団法人 日本循環器学会

キーワード

• Cardiac resynchronization therapy
• Dilated cardiomyopathy
• Echocardiography
• Heart failure

詳細情報

• CRID: 1390282680080886144
• NII論文ID: 10027427462
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-10-1221
• COI: 1:STN:280:DC%2BC3M7kvVSrsg%3D%3D
• ISSN: 13474820
• ISSN: 13469843
• PubMed: 21233574
• Web Site: http://www.jstage.jst.go.jp/article/circj/75/2/75_CJ-10-1221/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2011192622
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • PubMed
  • CiNii Articles
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