Improved coronary artery blood flow following the correction of systolic dyssynchrony with cardiac resynchronization therapy

Fang Fang, Joseph Yat Sun Chan, Alex Pui Wai Lee, Shih Hsien Sung, Xiu Xia Luo, Xin Jiang, Joey S.W. Kwong, John E. Sanderson, Cheuk Man Yu*

*此作品的通信作者

研究成果: Article同行評審

29 引文 斯高帕斯(Scopus)

摘要

Background: Coronary blood flow (CBF) is improved by cardiac resynchronization therapy (CRT) and impaired by right ventricular apical (RVA) pacing in patients with heart failure. However, the underlying mechanism remains unclear. Methods: Twenty-nine non-ischemic heart failure patients who responded to CRT underwent transthoracic echocardiography examination including both left anterior descending (LAD) CBF and tissue Doppler imaging in 3 pacing modes: intrinsic conduction, RVA pacing and biventricular (BiV) pacing. LAD velocity-temporal integral (LAD-VTI) and duration were measured. Systolic dyssynchrony was assessed with the standard deviation of a 12-left ventricular segmental model (Ts-SD). Results: BiV pacing improved while RVA pacing reduced CBF compared to intrinsic conduction (all p < 0.05). Both Ts-SD and ventricular septal velocity deteriorated during RVA pacing but improved during BiV pacing (all p < 0.05). When systolic dyssynchrony was induced, lower LAD-VTI (9.5 ± 3.4 versus 12.7 ± 5.1 cm, p = 0.001) and shorter LAD diastolic duration (483 ± 92 versus 542 ± 106 ms, p = 0.010) were detected than synchronous status. Systolic dyssynchrony was inversely related to septal velocity (r = - 0.41), p<0.001 and LAD-VTI (r = - 0.30, p = 0.007), with the latter found to be moderately correlated to septal velocity (r = 0.30, p = 0.007). Conclusion: Regional LAD flow was improved in patients subjected to BiV but worsened in those treated with RVA pacing in non-ischemic heart failure CRT responders. Systolic dyssynchrony was more commonly observed in patients subjected to RVA pacing. Reduction of septal velocity with dyssynchrony may directly lead to reduced LAD flow. Improvement of septal velocity by CRT and hence LAD flow may be an important mechanism in determining the response to CRT.

原文English
頁(從 - 到)2167-2171
頁數5
期刊International Journal of Cardiology
167
發行號5
DOIs
出版狀態Published - 1 9月 2013

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