ABSTRACT
UNLABELLED: The aim of our study was to identify electrocardiographic predictors of response to cardiac resynchronization therapy (CRT) in patients with dilated cardiomyopathy (DCM). METHODS: 46 patients with DCM (76% men; mean age 48.8+/-12 years; mean NYHA class 3.09+/-0.3; mean QRS duration 167+/-30.1 ms; left ventricular ejection fraction 23.5+/-6%) had CRT implanted. Assessment of clinical, laboratory and echocardiographic (including TDI) and 12-lead surface ECG parameters was performed at baseline, in 24 hours post CRT implantation and after 6 months of follow-up. Multivariate logistic regression analysis selected the following independent predictors of response to CRT: two pre-implantation - baseline RS width in lead V1 ≥ 113.5 ms (OR 0.94, 95% CI 0.814-1.00; p=0.000), BNP ≤ 456 g/ml (OR 0.92, 95% CI 0.797-1.00; p=0.001); and two post-implantation: shortening of QRS width - ΔQRS ≥ -24.5 ms (OR 0.80, 95% CI 0.586-1.00; p=0.01) and shortening of RS V1 width - ΔRSV1 ≥ -21.8 ms (S: 0.87, 95% CI 0.72-1.00; p= 0.002) in 24 hours after CRT.
Subject(s)
Cardiac Resynchronization Therapy/methods , Cardiomyopathy, Dilated , Electrocardiography/methods , Heart Failure , Stroke Volume , Adult , Cardiac Resynchronization Therapy Devices , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/physiopathology , Defibrillators, Implantable , Female , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/therapy , Humans , Logistic Models , Male , Middle Aged , Monitoring, Physiologic/methods , Outcome Assessment, Health Care/methods , Predictive Value of Tests , Severity of Illness IndexABSTRACT
Endomyocardial biopsy remains the gold standard of diagnosis of acute cellular rejection after heart transplantation. However, routine biopsies are of major inconvenience to patients and are also risky and costly. In the present research we considered possibility of non-invasive diagnosis of acute cellular rejection in patients after orthotopic heart transplantation. Results of research are based on studying 34 endomyocardial biopsys in combination with Holter monitoring and ECHO findings in 21 heart recipients. It is demonstrated that case follow-up with Holter monitoring and ECHO is mandatory for diagnosis of acute cellular rejection and optimal treatment tactics.
