Динамика структурно-функциональных показателей и толерантность к физической нагрузке левого желудочка у пациентов с имплантированным трехкамерным кардиостимулятором

Abstract

Цель настоящего исследования — изучить влияние электрокардиостимуляции в режиме DDD на структурные изменения полостей сердца и состояние внутрисердечной гемодинамики у больных с асинхронией желудочков. Проведение ресинхронизации сокращения миокарда с помощью бивентрикулярной кардиостимуляции достоверно улучшало такие параметры, как конечное диастолическое давление в левом желудочке, фракцию выброса левого желудочка, площадь митральной регургитации, функциональный класс по NYHA. Таким образом, данный метод лечения является весьма перспективным для широкого применения у пациентов с желудочковой асинхронией.

The aim of this study was to investigate the effect of pacing in DDD mode, the structural changes of the heart cavities and the condition of intracardiac hemodynamics in patients with ventricular asynchrony. The study was performed on the basis of Odessa Regional Hospital (Odessa, Ukraine). The study involved 20 patients with ventricular asynchrony, which was installed APM Biotronik Talos DR (US). Men were prevailed among surveyed persons — 65%. The age of patients ranged from 48 to 75 years, averaging (57.5±2.2) years. The patients were examined according to the requirements of the current clinical protocol, regulated by the order of Ministry of Health of Ukraine issued on 03.07.2006 No 436 “On approval of the provision of protocols of health care for the specialty “Cardiology””. All patients were assessed for degree of circulatory failure NYHA, exercise tolerance using a 6-minute walk test, an electrocardiogram was evaluated. Echocardiography was performed on the unit Phillips HD15 XE (UK). We measured performance linear cavities of the heart, the presence of tricuspid and mitral regurgitation, ejection fraction by Simpson and Teyholtz. Statistical processing has been done with the help of software Statistica 10.0 (StatSoft Inc., USA). At baseline, all patients had symptoms of heart failure. Functional class II heart failure is set in 65.0% of the patients, III functional class of heart failure — in 35%. Average test performance with a 6-minute walk test made (277.5±12.5) m, restitution time after exercise — (32.3±3.7) sec. All patients had elongated QRS complex to an average (131±7) ms. The average heart rate was (85.1±1.4) bpm, blood pressure — (118.8±1.6)/(69.9±1.4) mm Hg. Before treatment, the mean values of left ventricular CRA totaled (7.3±0.3) cm and DAC — (6.2±0.2) cm, which corresponds to the PV (30.5±2.7)%. After APM implantation CRA LV has decreased to (6.5±0.2) cm and DAC — to (4.9±0.3) Accordingly, the EF was (48.3±4.3)%. These changes were accompanied by an increase in exercise tolerance — to (314.8±11.1) m for the 6-minute walk test. Carrying reduce myocardial resynchronization using biventricular pacing significantly improved parameters such as end-diastolic pressure in the left ventricle ejection fraction, mitral regurgitation area, functional class NYHA. Thus, this method of treatment is very promising for widespread use in patients with ventricular asynchrony.