engleski

Detecting volume responders prior to CRT device implantation via mini-thoracotomy. The septal flash as a predictor of immediate LV reverse remodeling detectable by intraoperative echocardiography.

Background: Although cardiac resynchronization therapy (CRT) is well established as adjunctive heart failure treatment, a 30% rate of non-responders poses a challenge to improve the detection of potential responders prior to device implantation. A mechanism based approach to patient selection has been previously proposed, part of which is the septal flash as an echocardiographic sign of intraventricular dyssynchrony, predictive of CRT response. Methods: In this pilot study, data from 5 consecutive patents (2F/3M, 63± ; 10 years) referred for CRT implantation by mini-thoracotomy were analyzed. Intraoperative transthoracic or transoesophageal echocardiography as well as Doppler myocardial imaging data were acquired pre- and post-CRT device implantation. The septal flash was defined as an early ventricular septal motion within the isovolumic contraction period, imaged using gray-scale or Tissue Doppler colour M-mode. Reverse remodelling was defined as a reduction of end-systolic volume (LVESV) ≥ 10%. The right atrial and ventricular leads were placed transvenously, while the LV screw-in lead was positioned epicardially on the lateral wall, avoiding areas of magnetic resonance late-enhancement. Results: The septal flash was detected preoperatively in all patients and resolved immediately after onset of biventricular pacing. A significant post-implantation reduction of LVESV (248± ; 99 ml vs.190± ; 100 ml, P=0.01) and increase in EF (19± ; 5% vs. 27± ; 4%, P=0.01) were measured in all patients. Likewise, a significant increase of post-implantation dP/dt measured noninvasively from the mitral regurgitation trace was noted in all patients (321.3± ; 32.2 mmHg/s vs. 655.9± ; 29.8 mmHg/s, P=0.001). Conclusion: Preoperative presence of the septal flash is a valid predictor of LV reverse remodelling and increase in contractility which occur immediately after CRT-device implantation.

Cardiac Resynchronization Therapy; Left Ventricular Function; Intraoperative Echocardiography; Reverse Remodelling

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