Zusammenfassung
Nach dem Ergebnis mehrerer multizentrischer randomisierter Studien ist die kardiale Resynchronisationstherapie sicher und effektiv und hat in breitem Umfang Eingang in die klinische Praxis gefunden. Das Focus Update der europäische Leitlinien sieht eine Klasse-IA-Indikation bei Patienten mit einer Herzinsuffizienz NYHA II–IV bei einer LVEF≤35% und einer QRS-Breite von ≥120 ms (NYHA III/IV) oder ≥150 ms (NYHA II). Werden nach diesen Kriterien Patienten mit einem CRT-System versorgt, bleibt die Therapie bei etwa 30–35% der Fälle ohne den gewünschten Effekt. Da die pathophysiologische Basis des Krankheitsbilds, die gestörte elektromechanische Funktion bei LSB mit bildgebenden Verfahren analysiert werden kann, sind diese immer schon herangezogen worden, um den Erfolg einer CRT zu analysieren und vorauszusagen. Unter den Parametern die hierbei verwendet wurden, erwies sich aber keiner in der multizentrischen PROSPECT-Studie als ausreichend verlässlich um den Erfolg einer CRT vorauszusagen. Seit Veröffentlichung der PROSPECT-Studie 2008 sind aber weitere Studien in der Echokardiographie und im MRT durchgeführt werden, die in dieser Arbeit in den Kontext der Voruntersuchungen eingefügt werden.
Abstract
Several multicenter randomized clinical trials have established cardiac resynchronization as a safe and effective way to treat heart failure patients. This is reflected in the Focus Update of the European guidelines that describes a class IA indication in patients with NYHA class II–IV heart failure with LVEF≤35% and QRS≥120 ms (NYHA III/IV) or ≥150 ms (NYHA II). If applied in clinical practice, this patient selection results in ineffective treatment in about one third of patients implanted. Since the pathophysiological basis of the disease, a disorganized electromechanical function in patients with left bundle branch block (LBBB), is amenable to analysis with imaging methods, imaging has always played an important role in patient selection. None of the parameters used proved to be reliable for the prediction of cardiac resynchronization therapy success in the multicenter PROSPECT trial. Following the publication of PROSPECT in 2008, several new studies using echocardiography and cardiac magnetic resonance imaging were published. New publications are evaluated and analyzed in the context of earlier ones.
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Interessenkonflikte
Der korrespondierende Autor weist auf folgende Beziehung hin: Dr. Michael Neuß hat Vortragshonorare von Medtronic und St. Jude Medical erhalten. Darüber hinaus gehende Interessenkonflikte bestehen nicht.
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Neuß, M., Butter, C. Rolle der Bildgebung bei der kardialen Resynchronisationstherapie. Herzschr. Elektrophys. 22, 4–10 (2011). https://doi.org/10.1007/s00399-011-0116-3
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DOI: https://doi.org/10.1007/s00399-011-0116-3