engleski

Detecting Volume Responders prior to Implantation of a Cardiac Resynchronization Therapy Device via Minithoracotomy : The Septal Flash as a Predictor of Immediate Left Ventricular Reverse Remodeling

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 suggests the septal flash as a sign of intraventricular dyssynchrony, predictive of CRT responsiveness. In this pilot study, data from 5 consecutive patients (2F/3M, 62±9 years) referred for CRT implantation via a mini-thoracotomy were analyzed. Intraoperative transthoracic and/or transesophageal echocardiography as well as Doppler myocardial imaging data were acquired pre- and post-CRT device activation. The septal flash was defined as an early ventricular inward and outward septal motion within the isovolumic contraction period, imaged using gray-scale or Tissue Doppler color M-mode. Reverse remodeling 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. The septal flash was detected preoperatively in all patients and resolved immediately after onset of biventricular pacing. Immediately following pacemaker activation, a significant reduction of LVESV (248±99 ml vs.190±100 ml, p=0.01) and increase in EF (19±5% vs. 28±5%, p=0.01) were measured in all patients. Likewise, a significant increase of post-activation dP/dt measured noninvasively from the mitral regurgitation trace was noted in all patients (298.6±58.0 mmHg/s vs. 601.7±111.2 mmHg/s, p=0.001). Preoperative presence of the septal flash is a valid predictor of response to CRT. Immediately after CRT device activation, the septal flash disappears and LV reverse remodeling and an increase in contractility are observed.

cardiac resynchronization therapy; Intraoperative echocardiography; Left ventricular function; Left ventricular reverse remodeling; Doppler myocardial imaging

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