SEARCH FOR EFFECTIVENESS PREDICTORS OF BIVENTRICULAR STIMULATION IN PATIENTS WITH DRUG-REFRACTORY SEVERE CHRONIC HEART FAILURE

Aim. To reveal factors influencing the results of cardiac resynchronizing therapy (CRT) and to analyze the possibility of radionuclide investigation methods usage for evaluation of indications for this method.

Material and methods. Totally 64 patients included with dilated cardiomyopathy (DCMP) at the age of 32 to 75 y. o., with chronic heart failure (CHF) III NYHA, with left ventricle ejection fraction (EF LV) 30,1±3,8%, 6-minute walking test at 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 ml. All patients before CRT and after 1 year underwent Holter ECG monitoring. Patients were divided into 2 groups by the type of AF registration. Into the 1st group 40 patients included (62,5%) patients, who had permanent AF with 1-3 years anamnesis, mean 2±1,2 years. Second group consisted of 24 (37,5%) patients with sinus rhythm (SR). Before CRT 28 patients underwent balanced radionuclide ventriculography (BRVG) with EF LV increase estimation. To all the CRT devices were implanted with defibrillation function, and for patients with AF complete AV-block created.

Results. After 1 year all patients had positive clinical dynamics: LV EF increased to 42,8±4,8% (p≤0,001), HF class decreased from III to II, 6-minute distance increased to 377,2±45,3 m (p≤0,001). EDV LV decreased to 197,9±47,8 ml (p≤0,005). In 24 (37,5%) patients during a year sinus rhythm spontaneously returned. It was found that in patients with SR before the beginning of the study increase of EF during 1 year of CRT was 14%, and EDV decreased by 32 ml. In patients with permanent AF after 1 year CRT EF increased by 9%, and EDV decreased only by 13 ml. In patients with baseline AF and spontaneous SR EF increased by 13% and EDV decreased by 18 ml. Second stage of the study was the division of patients into two groups of responders and nonresponders by the level of EF increase after 12 months CRT and retrospective evaluation of metabolism defect of myocardium (MDM), measured by BRVG. Responders were the patients who, before CRT had MDM less than 15%, but if in increased 15%, patients were non-responders.

Conclusion. Hence the increase and maintenance of SR at the background of CRT in DCMP and AF helps to improve the parameters and clinical picture of CHF. Maintenance of fatty acid metabolism (MDM LV less than 15%) is a predictor of CRT effectiveness in DCMP. 

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