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Tái đồng bộ thất là cơ chế chính mang lại lợi ích từ liệu pháp tái đồng bộ tim
Tóm tắt
Mặc dù không có nhiều tranh cãi về việc liệu pháp tái đồng bộ tim (CRT) có thể mang lại lợi ích cho phần lớn bệnh nhân được chọn lựa theo các chỉ định thông thường, cơ chế chính xác của sự cải thiện có thể được xem là gây tranh cãi. Trong số những bệnh nhân được chọn có triệu chứng chức năng lớp III hoặc IV theo phân loại Hiệp hội Tim mạch New York, phân suất tống máu thất trái ≤35% và sự giãn QRS điện tâm đồ ít nhất 120–130 ms, khoảng 60–80% bệnh nhân đã cải thiện tùy thuộc vào định nghĩa về phản ứng được sử dụng. Mặc dù giả thuyết hợp lý là sự giãn QRS điện tâm đồ là một dấu hiệu thay thế cho sự chậm trễ trong kích hoạt cơ thất theo vùng, một khối lượng lớn dữ liệu đã chứng minh rằng có một nhóm bệnh nhân có các phức hợp QRS giãn mà không có sự không đồng bộ cơ học đáng kể. Lý do cho sự tách rời giữa sự phân tán điện và sự không đồng bộ cơ học hiện vẫn chưa được biết đến, nhưng nhiều nghiên cứu đã chứng minh được mối liên quan giữa sự không đồng bộ với kết quả thuận lợi sau CRT. Có thể quan trọng hơn, một số nghiên cứu hình ảnh (chủ yếu bằng siêu âm tim) đã chỉ ra rằng sự thiếu hụt không đồng bộ cơ học ban đầu là một dấu hiệu cho kết quả kém thuận lợi sau CRT. Gần đây, sự thiếu hụt không đồng bộ trước CRT đã được chỉ ra là có liên quan đến khả năng cao hơn đáng kể trong việc tránh khỏi cái chết, ghép tim hoặc cấy ghép thiết bị hỗ trợ thất trái trong dài hạn. Như là bằng chứng cơ chế thêm cho mối quan hệ giữa sự không đồng bộ cơ học và phản ứng chức năng thất trái với CRT, đã có đề xuất rằng những bệnh nhân không cải thiện các đo lường Doppler mô của sự không đồng bộ sau CRT có khả năng tái cấu trúc ngược thấp hơn. Chủ đề này đã bị làm phức tạp bởi những khó khăn kỹ thuật trong việc đo lường sự không đồng bộ cơ học qua mọi phương pháp hình ảnh, biến số gây nhiễu của sẹo trong bệnh lý thiếu máu cục bộ, và những định nghĩa phản ứng rất khác nhau được sử dụng bởi các nhà nghiên cứu khác nhau. Tuy nhiên, trọng lượng của bằng chứng từ một cơ sở bệnh sinh học cho đến các dữ liệu về kết quả bệnh nhân lâu dài gần đây mạnh mẽ hỗ trợ ý tưởng rằng sự tái đồng bộ là cơ chế chính mang lại lợi ích từ CRT.
Từ khóa
#liệu pháp tái đồng bộ tim #tái đồng bộ thất #không đồng bộ cơ học #kết quả bệnh nhân #phân suất tống máu thất tráiTài liệu tham khảo
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