Summary
The article analyses the status of functional tests used in patient selection for cardiac resynchronization therapy (CRT). Based on published randomized trials, the NYHA classification, the quality of life score, the 6-minute walk and the cardio-pulmonary exercise test (CPX) are reviewed. The NYHA classification is a weak and unspecific test and should be used only as a basic consideration in patient selection. The 6-minute walk test shows a wide spread of values and high dependency on patients’ motivation. Patients’ functional capacity is measured most objectively by the CPX test, which additionally stratifies prognosis. We conclude that functional capacity is an important criterion in patient selection for CRT. However, primary functional status is of minor importance in estimating the expected functional benefit since multiple factors influence the success of CRT.
Zusammenfassung
Diese Übersicht fasst die Wertigkeit der verschiedenen funktionellen Tests zusammen, die zur Auswahl potenzieller Patienten einer kardialen Resynchronisationstherapie herangezogen werden können. Es werden hierzu die NYHA-Klassifikation, der Lebensqualitätsfragebogen, der 6-min-Gehtest und die spiroergometrische Untersuchung analysiert und beurteilt. Die Bestimmung der NYHA-Klasse ist ein schwacher, unspezifischer Test und sollte nur zur grundsätzlichen Beurteilung herangezogen werden. Der 6-min-Gehtest ist ein relativ ungenauer und sehr von der Motivation des Patienten abhängiger Test. Die Spiroergometrie bestimmt die funktionelle Leistungsfähigkeit am objektivsten und liefert zusätzlich eine prognostische Aussage. Insgesamt spielt die Bestimmung der funktionellen Kapazität in der CRT-Patientenselektion eine wichtige Rolle. In der Vorhersagekraft eines funktionellen Zugewinns ist sie aufgrund der multiplen Einflussfaktoren auf einen CRT-Erfolg nur von untergeordneter Bedeutung.
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Schlegl, M., Butter, C. Die funktionelle Ausgangsleistung als Kriterium der Patientenselektion. Herzschr. Elektrophys. 17 (Suppl 1), i42–i50 (2006). https://doi.org/10.1007/s00399-006-1107-7
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DOI: https://doi.org/10.1007/s00399-006-1107-7