Zusammenfassung
Die kardiale Resynchronisationstherapie (CRT) soll die mechanische
Dyssynchronie bei Patienten mit Herzinsuffizienz und breitem QRS-Komplex
korrigieren. Bisher fußt die Indikation zur CRT vorwiegend
auf klinischen und elektrokardiographischen Kriterien. Da die QRS-Breite
nur schwach zur mechanischen Dyssynchronie korreliert ist, bieten sich
daher bildgebende Verfahren wie die Echokardiographie und die kardiale
Magnetresonanztomographie (MRT) zur Analyse der kardialen Dyssynchronie
an. Die Echokardiographie ist in zahlreichen Studien zur Identifikation
von geeigneten CRT-Kandidaten untersucht worden. Neben konventionellen
Verfahren wie M-Mode-, 2D-und Doppler-Echokardiographie wurden dazu
auch die Gewebe-Doppler-Echokardiographie und andere Techniken,
die in dieser Übersicht diskutiert werden, verwandt. Trotz
zahlreicher, positiver Ergebnisse in einzelnen Studien konnte kein
einzelner echokardiographischer Parameter in einer prospektiven,
multizentrischen Studie mit ausreichender Genauigkeit die CRT-Responder
identifizieren. Daher muß zum jetzigen Zeitpunkt die QRS-Breite weiterhin
als „Goldstandard” zur Patientenidentifikation
für die CRT angesehen werden. In Grenzfällen kann
möglicherweise eine Kombination verschiedener, echokardiographischer
Verfahren hilfreich sein. Die Ergebnisse mit neuen Techniken (2D-„Strain”-Analyse,
3D-Echokardiographie) müssen abgewartet werden. In der
Zukunft könnte die Magnetresonanztomographie eine größere Rolle
spielen.
Abstract
Cardiac resynchroinsation therapy (CRT) aims to correct the mechanical
dyssynchrony in patients with heart failure and broad QRS complex.
Until now, indication for CRT is based mainly on clinical and electrocardiographic
criteria. Because QRS width is only weakly correlated to mechanical
dyssynchrony, imaging techniques such as echocardiography and magnetic
resonance tomography (MRT) seem suitable for analysis of dyssynchrony.
Echocardiography has been studied in several studies for identification
of suitable CRT candidates. Apart from conventional methods such
as M mode-, 2 D-, and Doppler echocardiography other techniques which
will be discussed in this article, including tissue Doppler echocardiography,
have been used. Despite many positive results in individual studies
no single echocardiographic parameter was able to predict positive
CRT response in a prospective multicenter trial. Thus, QRS width
remains the ”gold standard” for CRT patient identification
at present. In borderline cases, a combination of several echocardiographic
measures of dyssynchrony may prove helpful. The results of studies
with new techniques such as 2-dimensional strain analysis or 3D-echocardiography
remain to be awaited. In the future, MRT may play a bigger role
in this setting.
Schlüsselwörter
Herzinsuffizienz - kardiale Resynchronisationstherapie - Echokardiographie - Kernspintomographie
- biventrikuläre Stimulation
Keywords
heart failure - cardiac resynchronisation therapy - echocardiography - magnetic resonance
imaging - biventricular stimulation
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Prof. Dr. med. Christoph Stellbrink
Klinik für Kardiologie und Internistische
Intensivmedizin, Städtische Kliniken Bielefeld
Teutoburger Str. 50
33604 Bielefeld
Telefon: 0521/5813401
Fax: 0521/5813498
