The Mid-term Effects Of Optimized Sequential Biventricular Resynchronization With Tissue Doppler Imaging

[Objective]Cardiac resynchronization therapy(CRT) could improve the cardiac function through optimizing the synchronization between atria and ventricules,left ventricle and right ventricle,and intra-left ventricle,further more it can also improve myocardial remodeling,resulting in excellent therapeutic effect in the patients with severe heart failure.Compared with the simultaneous biventricular pacing,the optimal biventricular pacing could improve the hemodynamics and synchronization of intra-left ventricular wall motion have been reported abroad.Few study of optimal biventricular pacing is reported at home.Tissue Dopplar technology were applied to evaluate mid-term effect of optimized sequential biventricular resynchronization on left ventricular systolic function and asynchrony.[Methodology] Cases of candidate:persistent congestive heart failure,NYHA cardiac function grade III-IV,left bundle branch block,QRS>120ms,LVEDD>55mm,LVEF< 0.35,Ts-SD>32.6ms,with or not with biventricular derangement.Fifteen patients with congestive heart failure who planed to receive cardiac resynchronization therapy were enrolled.Echocardiography and tissue Doppler imaging were carried out by GE vivid 7 with M3 s probe before implantation.The short-term changes were investigated after the individualized atrioventricular and interventricular delay programming.Patients were reexamined after one month,three months and six months respectively.The left ventricular ejection fraction(LVEF),GSCA,Tei index,left ventricular diastolic filling time interval,Tl-T2,Ts-SD,Tdis-SD,Tdis-MAX,VTI were measured when patient have ECHO examination.[Results]1.Simutaneous CRT immediately increased left ventricular ejection fraction from (0.28±0.07) to (0.36±0.10)(P<0.01) and GSCA from (3.4±0.93)ms to (4.l0±1.40)mm(P<0.0l).Moreover,Tl-T2 decreased from (54.47±27.42)ms to (16.4±10.81)ms(P<0.0l),and Ts-SD decreased from (70.45±23.30)ms to(41.19±24.48)ms(P<0.05).The Tei index,left ventricular diastolic filling time,Tdis-SD and Tdis-MAX also improved significantly.2.The individualized atrioventricular and interventricular delay programming caused a further increase in GSCA [from (4.10±1. 40)mm to (4.48±1.34)mm].However,the Ts-SD did not further decreased significantly.3.Six months of sequential CRT further improved LVEF and GSCA(P<0.05),and a significant reverse left ventricular remodeling was observed.The Tei index,left ventricular diastolic filling time,interventricular dyssynchrony and intraventricular dyssynchrony did not changed significantly. [Conclusion]l.Compared with simultaneous CRT,optimized sequential CRT significantly improves left ventricular performance immediately.2.Six months of pacing further improves left ventricular performance and remodeling.While the interventricular anti intraventricular dyssynchrony do not changed.