Terapia de resincronización cardiaca: experiencia, seguimiento clínico y ecocardiográfico, y optimización del dispositivo con ecocardiografía / Heart resynchronization therapy: experience, clinical follow-up and optimization of the device with echocardiography

RESUMEN

Antecedentes en pacientes con falla cardiaca avanzada, clase funcional III-IV, la mortalidad alcanza el 50 porciento a un año y el 80 porciento a dos años. Algunos permanecen sintomáticos y tienen pobre estado funcional a pesar del tratamiento farmacológico. La terapia de resincronización cardiaca es una alterativa terapéutica que mejora la hemodinámica y los síntomas en estos pacientes. Objetivo: analizar la experiencia en el manejo de la falla cardiaca con dispositivos de terapia de resincronización cardiaca con o sin cardiodesfibrilador. Diseño metodológico se realizó un estudio de intervención, sin asignación aleatoria de los pacientes, con evaluación antes y después de la intervención...

ABSTRACT

Antecedents in patients with advanced heart failure, functional class III-IV, mortality reaches 50% at one year and 80% at two years. Some remain asymptomatic and have a poor functional state, regardless of the pharmacologic treatment. Heart resynchronization therapy is a therapeutic alternative that improves hemodynamic and symptoms in these patients. Objective: to analyze the experience in the management of heart failure with heart resynchronization therapy devices with or without cardio defibrillator. Methodologic design: an intervention study without aleatory patients' assignment, with evaluation before and after the intervention. Results: the cohort was constituted by 82 patients. 73% were men. Mean age was 65.4 ± 11.9 years. The etiology was non-ischemic in 50 patients and ischemic in 32. Mean initial ejection fraction was 19.4% ± 11.7%. Initial functional class was class III - IV in 85% of cases and all patients received optimal medical treatment. During the follow-up, it was observed improvement of functional class, diastolic function, diastolic diameter of left ventricle, ejection fraction, mitral insufficiency, left atrial area, systolic lung pressure, synchrony parameters and myocardial function index with statistical significant difference in relation to the initial value (p<0.05). Survival at 44 months was 72%. Conclusion: the experience with heart resynchronization therapy and clinical and echocardiographic follow-up of the studied patients is similar to that found in other studies described in the literature.