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Echokardiographische Methoden zur Selektion für die kardiale Resynchronisationstherapie

Sind Tissue Doppler, Strain- und Strainrate-Imaging und 3D-Echokardiographie die ultimativen Methoden?

Echocardiographic evaluation to select patients for cardiac resynchronization therapy

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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.

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.

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Literatur

  1. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, Atee P, Messenger J, MIRACLE Study Group (2002) Multicenter InSync Randomized Clinical evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853

    PubMed  Google Scholar 

  2. Achilli A, Sassara M, Ficili S et al (2003) Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS. J Am Coll Cardiol 42:2117–2124

    Article  PubMed  Google Scholar 

  3. Alonso C, Leclercq C, Victor F, Mansour H, de Place C, Pavin D, Carré F, Mabo P, Daubert JC (1999) Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol 84:1417–1421

    Article  CAS  PubMed  Google Scholar 

  4. Alonso C, Ritter P, Leclercq C, Mabo P, Bailleul C, Daubert JC (2003) Effects of cardiac resynchronization therapy on heart rate variability in patients with chronic systolic heart failure and intraventricular conduction delay. Am J Cardiol 91:1144–1147

    Article  PubMed  Google Scholar 

  5. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Laurenti A, Fedele F, Santini M (2001) Doppler Myocardial Imaging in Patients with heart failure receiving biventricular pacing treatment. Am Heart J 142:881–896

    Article  CAS  PubMed  Google Scholar 

  6. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M (2002) Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. J Am Coll Cardiol 39:489–499

    Article  PubMed  Google Scholar 

  7. Auricchio A, Yu CM (2004) Beyond the measurement of QRS complex toward mechanical dyssynchrony: cardiac resynchronisation therapy in heart failure patients with a normal QRS duration. Heart 90:479–481

    Article  CAS  PubMed  Google Scholar 

  8. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M (2003) Biventricular pacing in heart failure: back to basics in the pathophysiology of left bundle branch block to reduce the number of nonresponders. Am J Cardiol 91:55F–61F

    Article  PubMed  Google Scholar 

  9. Bader H, Garrigue S, Lafitte S, Reuter S, Jais P, Haissaguerre M, Bonnet J, Clementy J, Roudaut R (2004) Intraleft ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 43:248–256

    Article  PubMed  Google Scholar 

  10. Bax JJ, Ansalone G, Breithardt OA, Derumeaux G, Leclercq C, Schalij MJ, Sogaard P, St John Sutton M, Nihoyannopoulos P (2004) Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use? A critical appraisal. J Am Coll Cardiol 44:1–9

    PubMed  Google Scholar 

  11. Bode-Schnurbus L, Bocker D, Block M, Gradaus R, Heinecke A, Breithardt G, Borggrefe M (2003) QRS duration: a simple marker for predicting cardiac mortality in ICD patients with heart failure. Heart 89:1157–1162

    Article  CAS  PubMed  Google Scholar 

  12. Bordachar P, Garrigue S, Lafitte S, Reuter S, Jais P, Haissaguerre M, Clementy J (2003) Interventricular and intra-left ventricular electromechanical delays in right ventricular paced patients with heart failure: implications for upgrading to biventricular stimulation. Heart 89:1401–1405

    Article  CAS  PubMed  Google Scholar 

  13. Borges AC, Kivelitz D, Walde T, Reibis RK, Grohmann A, Panda A, Wernecke KD, Rutsch W, Hamm B, Baumann G (2003) Apical tissue tracking echocardiography for characterization of regional left ventricular function: comparison with magnetic resonance imaging in patients after myocardial infarction. J Am Soc Echocardiogr 16:254–262

    PubMed  Google Scholar 

  14. Breithardt OA, Stellbrink C, Kramer AP, Sinha AM, Franke A, Salo R, Schiffgens B, Huvelle E, Auricchio A; PATH-CHF Study Group (2002) Pacing Therapies for Congestive Heart Failure. Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. J Am Coll Cardiol 40:536–545

    Article  PubMed  Google Scholar 

  15. Breithardt OA, Herbots L, D’Hooge J, Claus P, Bijnens B, Stellbrink C, Franke A, Sutherland GR (2004) Strain Rate Imaging in CRT Canditates. Eur Heart J 25:D16–D24

    Article  Google Scholar 

  16. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM (2004) Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. N Eng J Med 350:2140–2150

    CAS  Google Scholar 

  17. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC (2001) Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344:873–880

    CAS  Google Scholar 

  18. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Klein W, Tavazzi L for the Cardiac Resynchronization-Heart Failure (CARE-HF) study investigators (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1529–1549

    Google Scholar 

  19. Faber L, Lamp B, Vogt J, Horstkotte D (2004) Tissue Doppler imaging in patients with congestive heart failure and conduction disorders. Eur Heart J 25:D10–D15

    Google Scholar 

  20. Ghio S, Constantin C, Klersy C, Serio A, Fontana A, Campana C, Tavazzi L (2004) Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J 25:571–578

    PubMed  Google Scholar 

  21. Gorscan J, Kanzaki H, Bazaz R, Dohi K, Schwartzman D (2004) Usefulness of Echocardiografic Tissue Synchronization Imaging to Predict Acute Response to Cardiac Resynchronization Therapy. Am J Cardiol 93:1178–1181

    Google Scholar 

  22. Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RI, Antman EM, Alpert JS, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC Jr (2002) American College of Cardiology/American Heart Association Task Force on Practice Guidelines American College of Cardiology/American Heart Association/North American Society for Pacing and Electrophysiology Committee. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Cardiovasc Electrophysiol 11:1183–1199

    Google Scholar 

  23. Henein MY, Gibson DG (1995) Suppression of left ventricular early diastolic filling by long axis asynchrony. Br Heart J 73(2):151–157

    CAS  PubMed  Google Scholar 

  24. Ishigawa T, Sumita S, Kimura K, Kikuchi M, Kosuge M, Kuji N, Endo T, Sugano T, Sigemasa T, Kobayashi I, Tochikubo O, Usui T (1999) Prediction of optimal atrioventricular delay in patients with implanted DDD pacemakers. Pacing Clin Electrophysiol 22:1365–1371

    Google Scholar 

  25. Kanzaki H, Jacques D, Sade LE, Severyn DA, Schwartzman D, Gorcsan J 3rd (2003) Regional correlation by color-coded tissue Doppler to quantify improvements in mechanical left ventricular synchrony after biventricular pacing therapy. Am J Cardiol 92:752–755

    Article  PubMed  Google Scholar 

  26. Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, Nevo E (1999) Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 99:1567–1573

    CAS  PubMed  Google Scholar 

  27. Kawaguchi M, Murabayashi T, Fetics BJ, Nelson GS, Samejima H, Nevo E, Kass DA (2002) Quantitation of basal dyssynchrony and acute resynchronization from left or biventricular pacing by novel echo-contrast variability imaging. J Am Coll Cardiol 39:2052–2058

    PubMed  Google Scholar 

  28. Kindermann M, Frohlig G, Doerr T, Schieffer H (1997) Optimizing the AV delay in DDD pacemaker patients with high degree AV block: mitral valve Doppler versus impedance cardiography. Pacing Clin Electrophysiol 20:2453–2462

    CAS  PubMed  Google Scholar 

  29. Knebel F, Reibis RK, Bondke H-J, Witte J, Walde T, Eddicks S, Baumann G, Borges AC (2004) Tissue Doppler echocardiography and biventricular pacing in heart failure: patient selection, procedural guidance, follow-up, quantification of success. Cardiovasc Ultrasound 2:17–25

    PubMed  Google Scholar 

  30. Lafitte S, Garrigue S, Perron JM, Bordachar P, Reuter S, Jais P, Haissaguerre M, Clementy J, Roudaut R (2004) Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging. Eur J Heart Fail 6:203–212

    PubMed  Google Scholar 

  31. Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, Djiane P, Mabo P, Levy T, Gadler F, Bailleul C, Daubert JC (2002) Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 22:1780–1787

    Google Scholar 

  32. Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC (2002) Long-term benefits of biventricular pacing in congestive heart failure: results from the MUlti-site STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 40:111–118

    Article  PubMed  Google Scholar 

  33. Mele D, Pasanisi G, Heimdal A, Cittanti C, Guardigli G, Levine RA, Sutherland G, Ferrari R (2004) Improved recognition of dysfunctioning myocardial segments by longitudinal strain rate versus velocity in patients with myocardial infarction. J Am Soc Echocardiogr 17:313–321

    PubMed  Google Scholar 

  34. Moynihan PF, Parisi AF, Feldman CL (1981) Quantitative detection of regional left ventricular contraction abnormalities by two dimensional echocardiography. I. Analysis of methods. Circulation 63:752–760

    CAS  PubMed  Google Scholar 

  35. Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA (2000) Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 102:3053–3059

    CAS  PubMed  Google Scholar 

  36. Penicka M, Bartunek J, De Bruyne B, Vanderheyden M, Goethals M, De Zutter M, Brugada P, Geelen P (2004) Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation 109:978–983

    Article  PubMed  Google Scholar 

  37. Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, Guida P, Andriani A, Mastropasqua F, Rizzon P (2002) Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 40:1615–1622

    Article  PubMed  Google Scholar 

  38. Rouleau F, Merheb M, Geffroy S, Berthelot J, Chaleil D, Dupuis JM, Victor J, Geslin P (2001) Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy. Pacing Clin Electrophysiol 10:1500–1506.

    Google Scholar 

  39. Saxon LA, De Marco T, Schafer J, Chatterjee K, Kumar UN, Foster E; VIGOR Congestive Heart Failure Investigators (2002) Effects of longterm biventricular stimulation for resynchronization on echocardiographic measures of remodeling. Circulation 105:1304–1310

    Article  PubMed  Google Scholar 

  40. Schuster P, Faerestrand S, Ohm OJ (2003) Colour tissue velocity imaging can show resynchronisation of longitudinal left ventricular contraction pattern by biventricular pacing in patients with severe heart failure. Heart 89:859–864

    Article  CAS  PubMed  Google Scholar 

  41. Sogaard P, Egeblad H, Kim WY, Jensen HK, Pedersen AK, Kristensen BO, Mortensen PT (2002) Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol 40:723–730

    PubMed  Google Scholar 

  42. Sogaard P, Egeblad H, Pedersen AK, Kim WY, Kristensen BO, Hansen PS, Mortensen PT (2002) Sequential versus simultaneous biventricular resynchronization for severe heart failure: evaluation by tissue Doppler imaging. Circulation 106:2078–2084

    Article  PubMed  Google Scholar 

  43. Sun JP, Chinchoy E, Donal E, Popovic ZB, Perlic G, Asher CR, Greenberg NL, Grimm RA, Wilkoff BL, Thomas JD (2004) Evaluation of ventricular synchrony using novel Doppler echocardiographic indices in patients with heart failure receiving cardiac resynchronization therapy. J Am Soc Echocardiogr 17:845–850

    CAS  PubMed  Google Scholar 

  44. Sundell J, Engblom E, Koistinen J, Ylitalo A, Naum A, Stolen KQ, Kalliokoski R, Nekolla SG, Airaksinen KE, Bax JJ, Knuuti J (2004) The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure. J Am Coll Cardiol 43:1027–1033

    Article  PubMed  Google Scholar 

  45. Turner MS, Bleasdale RA, Vinereanu D, Mumford CE, Paul V, Fraser AG, Frenneaux MP (2004) Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundle-branch block: impact of left and biventricular pacing. Circulation 109:2544–2549

    Article  PubMed  Google Scholar 

  46. Turner MS, Bleasdale RA, Mumford CE et al. (2004) Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration. Heart 90:502–505

    Article  CAS  PubMed  Google Scholar 

  47. Veldhuisen van DJ, Dessel van PFHM (2005) Cardiac resynchronization therapy in chronic heart failure: how to select the patients that will benefit? Int J Cardiol 100:13–15

    Google Scholar 

  48. Venkateshwar K, Gottipaty VK, Krelis SP, Lu F, Spencer EP, Shusterman V, Weiss R, Brode S, White A, Anderson KP, White BG, Feldman AM For the VEST investigators (1999) The resting electrocardiogram provides a sensitive and inexpensive marker of prognosis in patients with chronic congestive heart failure. J Am Coll Cardiol 33:145

    Google Scholar 

  49. Vinereanu D, Bleasdale R, Turner M, Frenneaux MP, Fraser AG (2004) Comparison of left ventricular-biventricular pacing on ventricular synchrony, mitral regurgitation, and global left ventricular function in patients with severe chronic heart failure. Am J Cardiol 94 (4):519–521

    Article  PubMed  Google Scholar 

  50. Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP (2002) Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 105:438–445

    PubMed  Google Scholar 

  51. Yu CM, Fung WH, Lin H, Zhang Q, Sanderson JE, Lau CP (2002) Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 91:684–688

    Google Scholar 

  52. Yu CM, Lin H, Zhang Q, Sanderson JE (2003) High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 89:54–60

    PubMed  Google Scholar 

  53. Yu CM, Fung JW, Zhang Q, Chan CK, Chan YS, Lin H, Kum LC, Kong SL, Zhang Y, Sanderson JE (2004) Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation 110:66–73

    Article  PubMed  Google Scholar 

  54. Yu C-M, Zhang Q, Fung J, Chan H, Chan YS, Yip G, Kong SL, Zhang Y, Sanderson JE (2005) A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. J Am Coll Cardiol 45:677–684

    Article  PubMed  Google Scholar 

  55. Zahng Q, Yu C-M, Wing-Hong Fung J, Zhang Y, Chan Y-S, Chi-Kin Chan H, Yip GWK, Sanderson JE (2005) Assessment of the effect of cardiac resynchronization therapy on intraventricular mechanical synchronicity by regional volumetric changes. Am J Cardiol 95:126–129

    Google Scholar 

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  1. Medizinische Klinik der Charité, Charité Campus Mitte—Universitätsmedizin Berlin, Schumannstr. 20–21, 10117, Berlin

    A. C. Borges

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  2. F. Knebel
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  3. S. Eddicks
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  4. H.-J. Bondke
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Correspondence to A. C. Borges.

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Borges, A.C., Knebel, F., Eddicks, S. et al. Echokardiographische Methoden zur Selektion für die kardiale Resynchronisationstherapie. Herzschr. Elektrophys. 17 (Suppl 1), i63–i72 (2006). https://doi.org/10.1007/s00399-006-1110-z

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