NOVEL METHODS OF PATIENTS SELECTION FOR THE CARDIAC RESYNCHRONIZING THERAPY IN NON-ISCHEMIC CARDIOMYOPATHY

Aim. To study a range of selection methods for cardiac resynchroizing therapy (CRT) and to evaluate the possibility of their application in clinical practice for treatment improvement.

Material and methods. Totally 88 patients studied with the diagnosis dilation cardiomyopathy (DCMP) at the age 32-75 y. o. (55±12), HF III NYHA, ejection fraction (EF) of the LV (LV) was 30,1±3,8%, distance in 6-minute walking test — 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 ml, intra- and interventricular dyssynchrony was more than 120 ms. At the stage of selection the patients were separated to 3 groups: first — 28 patients — the defect of myocardium metabolism (DMM) was assessed using radionuclide methods; second — 24 patients — systolic velocity assessed of fibrous annulus of tricuspid valve of the right ventricle (Srv); third — 36 patients — controls.

Results. Control assessments were done in 1 year. Clinical responders for CRT were 69 patients (78,5%), not responded to CRT — 19 patients (21,5%). In assessment by the each method of selection it was revealed that in the 1st group there were 3 (10,7%) nonresponders, 6 (25%) in 2nd group, 10 (27,7%) in the 3rd. In the 1st group the responders were 25 (89,3%) of patients, whose LV DMM before CRT was 15%. If it was more than 15%, patients were nonresponders. In the second group the responders were 18 (75%) of patients, whose Srv before CRT was more than 10 m/s, in average — 12,5±2,1, (р=0,0001).

Conclusion. 1. Maintaining of myocardium metabolism (DMM LV less than 15%) is a predictor of CRT efficacy in DCMP patients. 2. Srv is an independent predictor of the CRT response and makes it with the sensitivity 85% and specificity 83% to reveal the responders to CRT at the stage of selection. 3. While selecting patients to CRT it is aimful to use all described methods together to improve quality of treatment.

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