バイブントリキュラーペースは,心不全および伝導遅延の患者におけるユニブントリキュラーペース中に存在する鈍化した力-周波数関係を改善します
Dirk Vollmann1, Lars Lüthje, Peter Schott
1Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany. DirkVollmann2000@aol.com
Circulation
|February 16, 2006
まとめ
バイベントリキュラーペースは,シングルサイトペースとは異なり,慢性心不全患者の心拍数が増加するにつれて心臓の機能を改善します. これは,ビバントリキュラーペースが再同期療法に機能的な利点をもたらすことを示唆しています.
科学分野:
- 心臓病学 心臓病学
- 心臓電気生理学 心臓電気生理学
- 心不全管理について
背景:
- 慢性心不全 (CHF) と伝導遅延の患者には,しばしばシストリック機能の障害があります.
- バイブントリキュラー (BiV) と左心室 (LV) のペースは,これらの患者の静止状態のシストリック機能を改善します.
- ペースが心拍数増加時に収縮機能に与える影響は十分に理解されていません.
研究 の 目的:
- 心筋梗塞の患者における心拍数増加における心収縮機能に対するBiVとユニブントリキュラーペースの差異的な効果を調査する.
- BiV,LV,右心室 (RV) ペースの時の力-周波数関係を比較する.
主な方法:
- 22人の心筋梗塞の患者は,心筋カテーテリゼーションを受けた.
- 左心室 (LV) の血動力学は,BiV,LV,RVの刺激中に,心拍数 (80,100,120,140bpm) の変動で測定されました.
- 評価された主要なパラメータには,LVの終端ダイアストリック圧力 (LVEDP),LVのシストリック圧力 (LVSP),およびdP/dtmaxが含まれています.
主要な成果:
- BiVとLVのペースは,ベースラインとRVのペースと比較して80bpmでdP/dtmaxを等しく増加させた.
- 心拍数を80から140bpmに上昇させると,BiVペースング中にdP/dtmaxが著しく増加した.
- 心拍数が増加するにつれて,単一場所のLVまたはRVペースで収縮性の有意な改善は観察されなかった.
- 140bpmでBiVのペースは,RVとLVのペースと比較して,LVEDPが低く,LVSPが高くなりました.
結論:
- 静脈刺激モードは,CHF患者の体内力-周波数関係を変化させます.
- 収縮機能は,BiV刺激中に心拍数が増加すると改善され,単一サイトペースとは違います.
- この強化された応答は,運動能力の向上に貢献し,心臓再同期療法のためのLVのみのペースに比べて潜在的な利点を提供します.
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