Echokardiographische Methoden zur Selektion für die kardiale Resynchronisationstherapie

Sind Tissue Doppler, Strain- und Strainrate-Imaging und 3D-Echokardiographie die ultimativen Methoden?
  • A. C. Borges
  • F. Knebel
  • S. Eddicks
  • H.-J. Bondke
  • G. Baumann
Article
  • 46 Downloads

Zusammenfassung

Die Verbreiterung des QRS-Komplexes und der Nachweis einer Asynchronie der myokardialen Kontraktion bei Herzinsuffizienz sind mit einer verschlechterten Prognose verbunden. Eine kardiale Resynchronisationstherapie (CRT) kann durch eine biventrikuläre Stimulation (BVP) zu einer hämodynamischen und klinischen Verbesserung und zu einem reversen Remodeling mit Verbesserung der Überlebensrate führen. Es existiert eine substanzielle Anzahl von Patienten mit QRS-Verbreiterung, die keine Verbesserung nach CRT aufweisen, und andererseits Patienten mit schwerer Herzinsuffizienz und schmalen QRS-Komplexen, die von einer BVP-Therapie profitieren. Die QRS-Breite kann also nur eingeschränkt den Erfolg einer BVP vorhersagen und korreliert nur wenig mit der echokardiographisch nachweisbaren mechanischen Asynchronie. Die Bestimmung der Asynchronie mittels Tissue Doppler Echokardiographie scheint der beste Prädiktor des BVP-Ansprechens zu sein, obwohl bisher kein Konsens hinsichtlich des Parameters der Asynchronie aus verschiedenen internationalen Studien erreicht werden konnte. Derzeit existieren überwiegend Ergebnisse aus retrospektiven Studien zur Bedeutung echokardiographischer Auswahlkriterien zur BVP-Therapie und nur eine prospektive Studie, die zusätzlich zu EKG-Kriterien auch echokardiographische Einschlusskriterien verwendete. Die neuen echokardiographischen Techniken werden in Zukunft die Auswahl der Patienten für eine BVP-Therapie verbessern, die Implantation optimieren und bei der Device-Programmierung assistieren.

Schlüsselwörter

Echokardiographie Resynchronisationstherapie Selektionskriterien 

Echocardiographic evaluation to select patients for cardiac resynchronization therapy

Summary

Wide QRS complex and asynchronous myocardial contraction in heart failure are associated with poor prognosis. Resynchronization can be achieved by biventricular pacing (BVP), which leads to hemodynamic and clinical improvement and reverse remodeling, and may improve survival. However, there is a substantial subset of patients with wide QRS complexes in the electrocardiogram who does not improve despite BVP, and there are findings which suggest that resynchronization therapy may be also beneficial for heart failure patients with normal QRS duration. QRS width predicts the benefit of BVP only with limitation and only correlates weakly with echocardiographically determined myocardial asynchrony. Determination of asynchrony by tissue Doppler echocardiography seems to be the best predictor for improvement after BVP, although no consensus on the optimal method to assess asynchrony has yet been achieved. To date, most studies evaluating tissue Doppler echo in BVP were performed retrospectively and only one prospective study with patient selection for BVP according to echocardiography and electrocardiography criteria of asynchrony has been published. These new echocardiographic tools will help to prospectively select patients for BVP, help to guide implantation and to optimize device programming.

Key words

Echocardiography resynchronization therapy patient selection 

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • A. C. Borges
    • 1
  • F. Knebel
  • S. Eddicks
  • H.-J. Bondke
  • G. Baumann
  1. 1.Medizinische Klinik der CharitéCharité Campus Mitte—Universitätsmedizin BerlinBerlin

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