疤痕心肌对crt疗效的影响及如何进行术前评估课件_1.pptVIP

20-30% MIRACLE 和 MIRACLE ICD 研究中CRT无反应率 CRT无反应的常见原因 患者选择不恰当 左室导线位置不理想 陈旧性心梗等造成大面积瘢痕 双室起搏比例较低 不恰当的AV和VV间期 左室导线脱位或失夺获 … 在2012年ESC，专家们首次制定了对心功能衰竭患者进行CRT时有关患者管理实践指南的国际共识声明  更好的让CRT发挥作用 对合适的病人 在合适的时机 在合理的左室部位起搏 结合充分合理的药物治疗 看护好，及时管理好CRT工作的方式 … 术前预测：结合非同步性, 疤痕 Dyssynchrony Scar tissue in LV lead Extensive scar (50% of LV) LV lead mismatch(vs site of latest mechanical activation) Heart failure patients – eligible for CRT LVEF 35% NYHA III-IV, QRS 120 Likelihood of CRT response? + - - - - + + + High Low Bax and Gorcsan: JACC 53:1933, 2009 心脏疤痕评价方法：期待影像学技术提高 超声组织应变率测定与磁共振技术应用  “CRT治疗能改善大多数心功能衰竭患者的症状、心功能，降低住院率和死亡率” “在治疗的临床实践方面我们至今还没达成一致的共识。我们的目的是建立植入术前、术中、术后管理方案的共识声明。我们不再讨论临床适应症的问题。” “我们试图弥补临床证据的不足，提供适用于任何植入术的CRT患者的评价和管理的实践指南。” 目前仍缺乏有关管理各方面的强有力临床证据。为此，大西洋两岸的专家联合发表了关于如何管理CRT患者的临床共识 更多合适病人植入 更多相关经验交流 更充分的CRT疗效！ * Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy Gabe B. Bleeker, MD; Theodorus A.M. Kaandorp, MD; Hildo J. Lamb, MD, PhD; Eric Boersma, PhD; Paul Steendijk, PhD; Albert de Roos, MD, PhD; Ernst E. van der Wall, MD, PhD; Martin J. Schalij, MD, PhD; Jeroen J. Bax, MD, PhD Background—Currently, one third of patients treated with cardiac resynchronization therapy (CRT) do not respond. Nonresponse to CRT may be explained by the presence of scar tissue in the posterolateral left ventricular (LV) segments, which may result in ineffective LV pacing and inadequate LV resynchronization. In the present study, the relationship between transmural posterolateral scar tissue and response to CRT was evaluated. Methods and Results—Forty consecutive patients with end-stage heart failure (NYHA class III/IV), LV ejection fraction 35%, QRS duration 120 ms, left bundle-branch block, and chronic coronary artery disease were included. The localization and transmurality of scar tissue were evaluated with contrast-enhanced MRI. Next, LV dyssynchrony was assessed at baseline and immediately after impl