左心室または双心室のペースは,拡張性心筋病症と左束枝ブロックの患者で,エネルギーコストを削減して心臓機能を改善します
G S Nelson1, R D Berger, B J Fetics
1Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Circulation
|January 11, 2000
まとめ
左心室または双心室ペースは,心筋縮性心筋症の患者で心筋縮性機能を改善しますが,心筋縮性心筋の酸素消費量は増加しません. この心臓再同期療法は,不同期性の心不全の貴重な治療戦略を提供します.
科学分野:
- 心臓病学 心臓病学
- 心不全に関する研究
- バイオメディカルエンジニアリング
背景:
- 導電遅延の拡張性心筋症 (DCM) 患者は,心室ペースを介してシストリック機能の改善を経験します.
- 静脈収縮機能を改善する従来の治療法では,しばしば心筋の酸素需要が増加します.
- この研究では,心室ペースが,エネルギー需要を増やすことなく,心筋収縮の利点を提供しているかどうかを調査しました.
研究 の 目的:
- 左心室または双心室のペースが,左束枝ブロックのDCM患者で心筋収縮機能を改善するかどうかを判断する.
- ドブタミンと比較して,心筋動脈の酸素消費量 (MVO(2) に対する心室ペースの影響を評価する.
主な方法:
- 10人のDCM患者の心臓キャセテリゼーションで,シヌスリズムとペースの際に血液動力学的パラメータとMVOを測定する.
- 7人のDCM患者におけるドブタミン注入によるペース効果の比較.
- 測定対象には,心室/大動脈圧,冠動脈血流,動脈と冠動脈のシヌス酸素差 (DeltaAVO) が含まれていた.
主要な成果:
- 左心室 (LV) のペースは,DCM患者において,シストリック機能 (動脈脈圧,dP/dt(max)) を有意に増加させた.
- LVパッシングは,DeltaAVO (((2) とMVO (((2) の減少につながり,エネルギーコストの低下を示した.
- ドブタミンは,シストリック機能を増加させましたが,パッシングと比較して,MVOを大幅に増加させました.
結論:
- LVまたはビブントリキュラーペースを介して心室再同期は,左束枝ブロックのDCM患者において,シストリック機能を急激に改善します.
- ペーシングセラピーはドブタミンとは異なり,心筋動脈のエネルギーコストをわずかに低下させます.
- このアプローチは,基礎不協和症を患っているDCM患者の有望な治療法です.
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