Širdies resinchronizuojamojo gydymo efektyvumo įvertinimas ir prognozavimas

Abstract

Chronic heart failure (HF) is the main cause determining increasing morbidity and mortality of the patients suffering from cardiovascular diseases related to sudden death or progressive heart insufficiency. Cardiac resynchronization therapy (CRT) is a progressive, modern and very promising method of non-medicament treatment of heart failure. Long-term data of observation (2002 – 2013 years) of the patients at the Clinic of Cardiology and Angiology of Vilnius University Hospital Santariškių Klinikos were collected, stored and analyzed, in order to evaluate the role of resynchronization in the process of the left ventricle recovery and re-modelling, decreasing all-cause morbidity and mortality. The experience gained allowed to form sufficient samples in patient groups that were less analyzed in large multicenter researches or were presented as results of metaanalysis of subgroups (patients with atrial fibrillation with or without the AV node block, CRT upgrade procedure, seniors (≥70 years old) groups). For the first time in Lithuania, we used imaging of adrenergic innervation of the heart with 123 I-MIGB (Iodine-123-metaiodobenzyl-guanidine) to evaluate global and regional adrenergic innervation of the heart in patients with heart failure and electrical conduction disorders; the further clinical course of these patients was prospectively followed-up, while implementing different methods of treatment (optimal medical treatment [OMT] or CRT). Based on obtained data, we have proposed algorithm of clinical decisions for advanced heart failure patients; it allows us to avoid application of expensive and time-exhausting treatment for the patients, who have no internal sources for improvement of their condition, also