为心脏重同步提供最佳左心室节奏部位的三维映射
Robert H Helm1, Melissa Byrne, Patrick A Helm
1Division of Cardiology, Johns Hopkins University, 720 Rutland Ave, Baltimore, MD 21205, USA.
Circulation
|February 14, 2007
概括
最佳的心脏再同步治疗 (CRT) 是通过左心室 (LV) 在侧壁上的置而实现的. 这种广泛的区域,覆盖约43%的LV自由壁,改善心脏功能在正常和失败的心脏.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 医疗成像医学成像
背景情况:
- 心脏再同步治疗 (CRT) 的有效性取决于在晚期激活区域内精确的左心室 (LV) 位.
- 最佳LVCRT站点的确切3D分布和地理范围尚未得到充分了解.
研究的目的:
- 确定最佳CRT产生的LV站点的3D分布和地理范围.
- 为了评估最佳的CRT位点是否在正常的心脏和失败的心脏之间有所不同.
主要方法:
- 采用正常或失败的心脏的狗模型,通过节奏或移除诱导异步.
- 采用带有128个电极的上心,用于双心室CRT刺激和记录.
- 在各种 LV 部位评估整体心脏功能 (导电导管) 和机械同步 (MRI 标记).
主要成果:
- 最佳CRT始终从LV侧壁部位,稍微前部和顶部实现.
- 提供≥70%最大dP/dtmax增加的LV部位覆盖了LV自由壁的约43%.
- 这种最佳区域在正常和失败的心脏中是相似的,并且与MRI衍生的机械同步图相关联.
结论:
- 优化的CRT可以在LV侧壁的广泛区域实现,无论是正常心脏还是失败的心脏.
- 与最佳侧部位相对较小的前后偏差仍然可以产生有效的CRT.
- 最大限度地提高机械同步的站点通常与改善整体心脏功能的站点保持一致,为CRT优化验证墙壁运动分析.
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