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The Relationship Between Narrowing Of The QRS Duration And Improvement In The 6-Minute Walking Distance After Cardiac Resynchronization Theraphy

Yıl 2021, Cilt: 3 Sayı: 1, 6 - 12, 28.02.2021

Öz

Objective: Cardiac resynchronization therapy has been proved to be effective in patients suffering from reduced ejection fraction heart failure related to electrical dyssynchrony. The aim of this study was to investigate the relationship among narrowing of the QRS duration after cardiac resynchronization therapy and the evaluation of functional capacity by 6-minute walking test.


Material and Method: A total of 39 symptomatic (NYHA class II-IV) patients (24 females, 19 males) with chronic heart failure (38% ischemic, 62% non-ischemic) who had left ventricle ejection fraction ≤ 35% were included into the study.


Results:
The evaluation after cardiac resynchronization therapy revealed statistically significant decrease in QRS duration (153.62 ± 8.49 vs. 131.44 ± 9.86 msec, p < 0.001) and increase in 6-minute walking distance (247.77 ± 52.93 vs. 361.15 ± 66.17 m, p < 0.001) compared to before cardiac resynchronization therapy. It was detected moderate negative correlation (r = -0.52, p < 0.001) between narrowing of the QRS duration and 6-minute walking distance after cardiac resynchronization therapy.


Conclusion:
In patients with reduced ejection fraction heart failure and cardiac resynchronization therapy, our study has shown that increase in narrowing QRS duration after cardiac resynchronization therapy implantation is associated with development in 6-minute walking distance.

Kaynakça

  • Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association, 2000.
  • Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). Cardiac resynchronization in chronic heart failure. New England Journal of Medicine, 346(24), 1845-1853.
  • Cazeau, S., Leclercq, C., Lavergne, T., Walker, S., Varma, C., Linde, C., et al. (2001). Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. New England Journal of Medicine, 344(12), 873-880.
  • Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., et al. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350(21), 2140-2150.
  • Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352(15), 1539-1549.
  • Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of exercise testing and interpretation, 3rd edition. Philadelphia: Lippincott, Williams & Wilkins; 1999.
  • Weisman IM, Zeballos RJ. An integrated approach to the interpretation of cardiopulmonary exercise testing. Clin Chest Med 1994;15:421–445.
  • Woo M. A., Moser D. K., Stevenson L. W., Stevenson W. G.Six-minute walk test and heart rate variability: lack of association in advanced stages of heart failure. Am. J. Respir. Crit. Care Med. 61997348354
  • Cahalin L. P., Mathier M. A., Semigran M. J., Dec G. W., DiSalvo T. G.The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 1101996325332
  • Roul G., Germain P., Bareiss P. Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure? Am. Heart J. 1361998449457
  • Vidal B, Sitges M, Marigliano A, Delgado V, Diaz-Infante E, Azqueta M, et al. Optimizing the programmation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block, Am J Cardiol , 2007, vol. 100 (pg. 1002-6)
  • Shiota T, Jones M, Teien DE, Yamada I, Passafini A, Ge S, et al. . Evaluation of mitral regurgitation using a digitally determined color Doppler flow convergence ‘centerline’ acceleration method. Studies in an animal model with quantified mitral regurgitation, Circulation , 1994, vol. 89 (pg. 2879-87).
  • American Society of Echocardiography Committee on Standards. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2:358–367.
  • ATS StatementGuidelines for the six-minute walk test, Am J Respir Crit Care Med , 2002, vol. 166 (pg. 111-7).
  • Bakker, P. F., Meijburg, H. W., De Vries, J. W., Mower, M. M., Thomas, A. C., Hull, M. L.,et al. (2000). Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. Journal of interventional cardiac electrophysiology, 4(2), 395-404.
  • Pilote L, Sliberberg J, Lisbona R, Sniderman A. Prognosis in patients with low left ventricular ejection fraction after myocardial infarction: importance of exercise capacity, Circulation , 1989, vol. 80 (pg. 1636-41)
  • Opasich C, Pinna G, Mazza A, Febo O, Riccardi R, Capomolla S, et al. Six-minute walking performance in patients with moderate-to-severe heart failure, Eur Heart J , 2001, vol. 22 (pg. 488-96).
  • Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, et al. Prognosis value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation, Eur J Heart Fail , 2003, vol. 5 (pg. 247-52).
  • Martins V, Drumond C, Martins JL, Westerlund M. Prognostic value of the six-minute walk test in heart failure, Arq Bras Cardiol , 2006, vol. 86 (pg. 120-125) .
  • Chua TP, Ponikowski P, Harrington D, Anker SD, Webb-Peploe K, Clark AL, et al. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure, J Am Coll Cardiol , 1997, vol. 29 (pg. 1585-90)
  • Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LHJr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure, Circulation , 1991, vol. 83 (pg. 778-86)
  • Szlachcic J, Massie BM, Kramer BL, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure, Am J Cardiol , 1985, vol. 55 (pg. 1037-42)
  • Mehra MR, Lavie CJ, Milani RV. Predicting prognosis in advanced heart failure, Chest , 1996, vol. 110 (pg. 310-2)
  • Faggiano, P., D’Aloia, A., Gualeni, A., Lavatelli, A., & Giordano, A. (1997). Assessment of oxygen uptake during the 6-minute walking test in patients with heart failure: preliminary experience with a portable device. American heart journal, 134(2), 203-206.
  • Guyatt, G. H., Thompson, P. J., Berman, L. B., Sullivan, M. J., Townsend, M., Jones, N. L., et al. (1985) How should we measure function in patients with chronic heart and lung disease?. Journal of chronic diseases, 38(6), 517-524.
  • María Ángeles Castel, Francisco Méndez, David Tamborero, Lluís Mont, Santiago Magnani, Jose Maria Tolosana, et al; Six-minute walking test predicts long-term cardiac death in patients who received cardiac resynchronization therapy. Europace 2009; 11 (3): 338-342.
  • Linde, C., Leclercq, C., Rex, S., Garrigue, S., Lavergne, T., Cazeau, S., et al (2002). Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. Journal of the American College of Cardiology, 40(1), 111-118.

Kardiyak Resenkronizasyon Tedavisi Sonrası 6 Dakikalık Yürüme Mesafesinde İyileşme ile QRS Süresindeki Daralma Arasındaki İlişki

Yıl 2021, Cilt: 3 Sayı: 1, 6 - 12, 28.02.2021

Öz

Amaç: Kardiyak resenkronizasyon tedavisinin, elektriksel dissenkroniye bağlı azalmış ejeksiyon fraksiyonlu kalp yetmezliği olan hastalarda etkili olduğu kanıtlanmıştır. Bu çalışmanın amacı, kardiyak resenkronizasyon tedavisi sonrası QRS süresindeki daralma ile fonksiyonel kapasitenin bir göstergesi olan 6 dakikalık yürüme mesafesi ile arasındaki ilişkiyi incelemektir.


Gereç ve Yöntem:
Çalışmaya sol ventrikül ejeksiyon fraksiyonu ≤%35 olan kronik kalp yetmezliği ile takip edilen (%38 iskemik, %62 iskemik olmayan) toplam 39 semptomatik (New York Heart Association sınıf II-IV) hasta (24 kadın, 19 erkek) dahil edildi.


Bulgular:
Kardiyak resenkronizasyon tedavisi öncesine kıyasla, kardiyak resenkronizasyon tedavisi sonrası değerlendirmede QRS süresinde istatistiksel olarak anlamlı azalma (153.62 ± 8.49 ve 131.44 ± 9.86 msn, p <0.001) ve 6 dakikalık yürüme mesafesinde artış (247.77 ± 52.93 vs. 361.15 ± 66.17 m, p <0.001). QRS süresindeki daralma ile kardiyak resenkronizasyon tedavisi sonrası 6 dakikalık yürüme mesafesi arasında orta derecede negatif korelasyon (r = -0.52, p <0.001) tespit edildi.


Sonuç: Çalışmamız, azalmış ejeksiyon fraksiyonlu kalp yetmezliği ve kardiyak resenkronizasyon tedavisi hastalarında, kardiyak resenkronizasyon tedavisi implantasyonu sonrası QRS süresindeki daralmanın 6 dakikalık yürüme mesafesindeki artış ile ilişkili olduğunu göstermiştir.

Kaynakça

  • Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association, 2000.
  • Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). Cardiac resynchronization in chronic heart failure. New England Journal of Medicine, 346(24), 1845-1853.
  • Cazeau, S., Leclercq, C., Lavergne, T., Walker, S., Varma, C., Linde, C., et al. (2001). Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. New England Journal of Medicine, 344(12), 873-880.
  • Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., et al. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350(21), 2140-2150.
  • Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352(15), 1539-1549.
  • Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of exercise testing and interpretation, 3rd edition. Philadelphia: Lippincott, Williams & Wilkins; 1999.
  • Weisman IM, Zeballos RJ. An integrated approach to the interpretation of cardiopulmonary exercise testing. Clin Chest Med 1994;15:421–445.
  • Woo M. A., Moser D. K., Stevenson L. W., Stevenson W. G.Six-minute walk test and heart rate variability: lack of association in advanced stages of heart failure. Am. J. Respir. Crit. Care Med. 61997348354
  • Cahalin L. P., Mathier M. A., Semigran M. J., Dec G. W., DiSalvo T. G.The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 1101996325332
  • Roul G., Germain P., Bareiss P. Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure? Am. Heart J. 1361998449457
  • Vidal B, Sitges M, Marigliano A, Delgado V, Diaz-Infante E, Azqueta M, et al. Optimizing the programmation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block, Am J Cardiol , 2007, vol. 100 (pg. 1002-6)
  • Shiota T, Jones M, Teien DE, Yamada I, Passafini A, Ge S, et al. . Evaluation of mitral regurgitation using a digitally determined color Doppler flow convergence ‘centerline’ acceleration method. Studies in an animal model with quantified mitral regurgitation, Circulation , 1994, vol. 89 (pg. 2879-87).
  • American Society of Echocardiography Committee on Standards. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2:358–367.
  • ATS StatementGuidelines for the six-minute walk test, Am J Respir Crit Care Med , 2002, vol. 166 (pg. 111-7).
  • Bakker, P. F., Meijburg, H. W., De Vries, J. W., Mower, M. M., Thomas, A. C., Hull, M. L.,et al. (2000). Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. Journal of interventional cardiac electrophysiology, 4(2), 395-404.
  • Pilote L, Sliberberg J, Lisbona R, Sniderman A. Prognosis in patients with low left ventricular ejection fraction after myocardial infarction: importance of exercise capacity, Circulation , 1989, vol. 80 (pg. 1636-41)
  • Opasich C, Pinna G, Mazza A, Febo O, Riccardi R, Capomolla S, et al. Six-minute walking performance in patients with moderate-to-severe heart failure, Eur Heart J , 2001, vol. 22 (pg. 488-96).
  • Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, et al. Prognosis value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation, Eur J Heart Fail , 2003, vol. 5 (pg. 247-52).
  • Martins V, Drumond C, Martins JL, Westerlund M. Prognostic value of the six-minute walk test in heart failure, Arq Bras Cardiol , 2006, vol. 86 (pg. 120-125) .
  • Chua TP, Ponikowski P, Harrington D, Anker SD, Webb-Peploe K, Clark AL, et al. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure, J Am Coll Cardiol , 1997, vol. 29 (pg. 1585-90)
  • Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LHJr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure, Circulation , 1991, vol. 83 (pg. 778-86)
  • Szlachcic J, Massie BM, Kramer BL, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure, Am J Cardiol , 1985, vol. 55 (pg. 1037-42)
  • Mehra MR, Lavie CJ, Milani RV. Predicting prognosis in advanced heart failure, Chest , 1996, vol. 110 (pg. 310-2)
  • Faggiano, P., D’Aloia, A., Gualeni, A., Lavatelli, A., & Giordano, A. (1997). Assessment of oxygen uptake during the 6-minute walking test in patients with heart failure: preliminary experience with a portable device. American heart journal, 134(2), 203-206.
  • Guyatt, G. H., Thompson, P. J., Berman, L. B., Sullivan, M. J., Townsend, M., Jones, N. L., et al. (1985) How should we measure function in patients with chronic heart and lung disease?. Journal of chronic diseases, 38(6), 517-524.
  • María Ángeles Castel, Francisco Méndez, David Tamborero, Lluís Mont, Santiago Magnani, Jose Maria Tolosana, et al; Six-minute walking test predicts long-term cardiac death in patients who received cardiac resynchronization therapy. Europace 2009; 11 (3): 338-342.
  • Linde, C., Leclercq, C., Rex, S., Garrigue, S., Lavergne, T., Cazeau, S., et al (2002). Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. Journal of the American College of Cardiology, 40(1), 111-118.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Mert Evlıce 0000-0003-4733-6348

Mustafa Akcakoyun 0000-0003-0940-6229

Yayımlanma Tarihi 28 Şubat 2021
Gönderilme Tarihi 12 Ekim 2020
Kabul Tarihi 9 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 3 Sayı: 1

Kaynak Göster

AMA Evlıce M, Akcakoyun M. The Relationship Between Narrowing Of The QRS Duration And Improvement In The 6-Minute Walking Distance After Cardiac Resynchronization Theraphy. Hitit Medical Journal. Şubat 2021;3(1):6-12.