RIGHT VENTRICLE MYOCARDIUM CONTRACTILITY AS PARAMETER OF CARDIAC RESYNCHRONIZATION EFFICACY

Aim. To evaluate the significance of the right ventricle (RV) myocardium contractility in assessment of cardiac resynchronization therapy (CRT).

Material and methods. Totally, 80 patients included, with dilation cardiomyopathy (49 males, 31 females), mean age 54±10,5 y.o.), heart failure (HF) of III functional class (FC) by NYHA, ejection fraction (EF) of the left ventricle (LV) was 30,1±3,8%, 6-minute walking distance — 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 mL. Stable sinus rhythm was found in 45 patients, and chronic medication resistant atrial fibrillation — in35. In patients, the disorders of intraventricular conduction were found as the His left bundle branch block with QRS width from 146 ms to 240 ms (183±32 ms). Implanting of the resynchronization device was done by standard method for biventricular electrocardiostimulation. Permanent atrial fibrillation patients, as 2nd step, underwent complete atrioventricular block formation. In all patients, by radionuclide equal tomoventriculography, the contractility was studied, of the left and right ventricle myocardium, before CRT and 12 moths post-procedure.

Results. Control study was conducted in 1 year; positive clinical dynamics was noticed: FC of HF decreased from III to II. Clinical responders were 69 patients (86,25%), did not respond 11 (13,75%). As the criteria of the “respond” on CRT we used increased 15% and more EF during 12 months. Among the responders, there was positive clinical dynamics: EF of LV increased from 30,1±3,8% to 42,8±4,8% (p≤0,001), LV EDV decreased from 220,7±50,9 to 197,9±47,8 mL (p≤0,005), in nonresponders EF LV remained almost unchanged: from 30,1±3,8% to 33,8±3,8% (p≤0,001), and EDV of LV increased: 220,7±50,9 to 227,8±27,8 mL (p≤0,001). All participants were retrospectively selected into 2 groups: responders and nonresponders on CRT. Radionuclide tomoventriculography was used for the changes for 12 months ofLV and RV contractility investigation. Maximum filling rate and the mean filling velocity during 1/3 of diastole were significantly worse in the 2nd group patients, by 30% and 60%, respectively. Other parameters in the groups did not differ significantly.

Conclusion. Hence, the data points on the relation of RV contractility improvement by CRT with positive cardiac resynchronization, together with the improvement of theLV contractility. Resynchronization in severe chronic HF patients, with saved contractility of the right chambers, is more effective, and higher scintigraphical values of maximum filling rate and the mean filling velocity during 1/3 of diastole might be prognosis criteria of positive response on CRT.

1. 2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy. Russ. J. Cardiol. 2014; 4 (108): 5-63. Russian (Рекомендации по кардиостимуляции и сердечной ресинхронизирующей терапии. Российский кардиологический журнал. 2014; 4 (108): 5-63).

2. Bax JJ, Abraham T, Barold SS, et al. Cardiac Resynchronization Therapy. JACC. 2005; 46(12): 2168-82.

3. Lebedev DI, Zlobina MV, Gulya MO, et al. Novel methods of patients selection for the cardiac resynchronizing therapy in non-Ischemic cardiomyopathy. Russian Journal of Cardiology. 2015; (11): 29-34. Russian (Лебедев Д.И., Злобина М.В., Гуля М.О., и др. Новые методы отбора пациентов с неишемической кардиомиопатией для проведения сердечной ресинхронизирующей терапии. Российский кардиологический журнал. 2015; (11): 29-34).

4. Popov SV, Savenkova GM, Antonchenko IV. Effects of cardiac resynchronization therapy in the treatment of congestive heart failure. Siberian Journal of Medical (Tomsk city) 2010; 25(2-1): 25-33. Russian (Попов С.В., Савенкова Г.М., Антонченко И.В. и др. Эффекты кардиоресинхронизирующей терапии в лечении застойной сердечной недостаточности. Сибирский медицинский журнал (г. Томск). 2010; 25(2-1): 25-33).

5. Wells G, Parkash R, Healey JS, et al. Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials. CMAJ 2011; 183: 421-9.

6. Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008; 117: 2608-16.

7. Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008; 117(13): 1717-31.

8. Baur LHB. Gated blood pool SPECT: A new clinical tool to detect cardiac dyssynchrony? Int J Cardiovasc Imaging 2008; 24: 727-8.

9. Mangiavacchi M, Gasparini M, Faletra F, et al. Clinical predictors of marked improvement in left ventricular performance after cardiac resynchronization therapy in patients with chronic heart failure. Am Heart J 2006; 151(2): 477.e1-477.e6.

10. Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008; 117: 2608-16.

11. Gulja MO, Lishmanov JuB, Zavadovskij KV, et al. Status of fatty acid metabolism in the myocardium of the left ventricle and the forecast efficiency Cardiac resynchronization therapy in patients with dilated cardiomyopathy. Russ J Cardiol. 2014; 9: 61-7. Russian (Гуля М.О., Лишманов Ю.В., Завадовский К.В. и др. Состояние метаболизма жирных кислот в миокарде левого желудочка и прогноз эффективности кардиоресинхронизирующей терапии у пациентов с дилатационной кардиомиопатией. Российский кардиологический журнал 2014; 9: 61-7).

12. de Groote P, Fertin M, Goéminne C, et al. Right ventricular systolic function for risk stratification in patients with stable left ventricular systolic dysfunction: comparison of radionuclide angiography to echoDopplerparameters. Eur Heart J. 2012 Nov; 33 (21): 2672-9.

13. Tabereaux PB, Doppalapudi H, Kay GN, et al. Limited response to cardiac resynchronization therapy in patients with concomitant right ventricular dysfunction. J Cardiovasc Electrophysiol. 2009; 19: 1-5.

14. Lebedev DI, Minin SM, Krivolapov SN. Prognostic assessment of the effectiveness of biventricular pacing in patients with severe heart failure. Serdechnaja nedostatochnost’ Journal. 2013; 14, 2 (76): 82-8. Russian (Лебедев Д.И., Минин С.М., Криволапов С.Н. Прогностическая оценка эффективности бивентрикулярной стимуляции у пациентов с тяжелой сердечной недостаточностью. Ж. сердечная недостаточность. 2013; 14, 2 (76): 82-8).

15. Lishmanov YB, Chernov VI, Krivonogov NG, et al. Radionuclide methods in the diagnosis of cardiovascular diseases. Siberian Journal of Medicine (Tomsk) 2010; 25(4): 8-13. Russian (Лишманов Ю.Б., Чернов В.И., Кривоногов Н. Г., и др. Радионуклидные методы исследования в диагностике сердечно-сосудистых заболеваний. Сибирский медицинский журнал (Томск) 2010; 25(4): 8-13).

16. Zlobina MV, Sokolov AA, Popov SV, et al. Preservation of diastolic function of right ventricular as important sign of response to cardiac resynchronization therapy. Fundamental’nye issledovanija Journal. 2013; 12, 2: 214-7. Russian (Злобина М.В., Соколов А.А., Попов С.В. и др. Сохранность систолической функции правого желудочка важный признак ответа на сердечную ресинхронизирующую терапию. Фундаментальные исследования 2013; 12, 2: 214-7).