Ein unkoordinierter linksventrikulärer Kontraktionsablauf bei Patienten mit chronischer Herzinsuffizienz trägt unabhängig von der zellulären myokardialen Schädigung entscheidend zur hämodynamischen Funktionseinschränkung des linken Ventrikels bei. Eine Verbesserung der hämodynamischen Situation kann mit Einsatz der biventrikulären Stimulation im Rahmen der kardialen Resynchronisationstherapie erreicht werden. Diese Therapie führt bei Patienten mit symptomatischer Herzinsuffizienz, EF<35 % und einer QRS-Breite > 120 ms zu einer symptomatischen Verbesserung und zu einer Mortalitätsreduktion. Etwa ein Drittel der nach den genannten Kriterien ausgewählten Patienten zeigt jedoch keine objektivierbare Verbesserung unter biventrikulärer Stimulation. Die QRS-Breite scheint als alleiniges Kriterium der Asynchronie nicht ausreichend präzise für die Patientenselektion zu sein. Demgegenüber bietet die Echokardiographie vielfältige ergänzende Ansatzmöglichkeiten zur verbesserten Quantifizierung der kontraktilen Asynchronie, welche im vorliegenden Beitrag diskutiert werden.
Summary
An uncoordinated left ventricular contraction sequence contributes significantly to the impaired hemodynamic function in patients with chronic heart failure. Cardiac resynchronization therapy with biventricular pacing may improve heart failure symptoms and exercise tolerance and reduce cardiac mortality in patients with severe chronic heart failure, depressed systolic left ventricular function (EF<35 %) and a QRS duration > 120 ms. However, about one third of patients with implanted pacemakers do not respond favorably to resynchronisation therapy. This may be related to the limited diagnostic value of QRS duration for the identification of mechanical dyssynchrony. Echocardiography allows identification of mechanical dyssynchrony with a high diagnostic sensitivity and may improve the selection of patients suitable for biventricular pacing. This article discusses proposed echocrdiographic approaches for quantification of dyssynchrony.
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