Ventricular ressincronization mini review

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pequena revisao sobre terapia de ressincronizacao cardiaca abordando alguns trials importantes sobre o assunto assim como os guidelines vigentes.

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  • Sóenvolveupctes com QRS > 150 oupctes entre 120-150ms com dissincroniaao Eco.
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  • This slide lays out the overall objective of the presentation; which is how to achieve or start working towards a “successful retirement”. It starts with a “written financial plan”, and moves clock-wise – all centered around the main goal. On this continuum, buttons can be added or removed, depending upon the financial professional giving the presentation.A successful retirement plan has many moving parts and each of them must serve a unique function in carrying you to retirement. Regardless of your situation, the journey to retirement is likely dotted with some storms and choppy seas along the way. Here, I have laid out what I believe to be the very basic principles necessary for any successful retirement plan.
  • Ventricular ressincronization mini review

    1. 1. Christophe Leclercq and Joshua M. Hare Circulation 2004<br />Ventricular Resynchronization: Current State of the ArtMini Review<br />Apresentadopor<br />Carlos Alexandre Volponi Lovatto<br />R1 ClínicaMédica H. Heliópolis<br />
    2. 2. Consequências da Dissincronia.<br />Preditor de piora da falência de VE, MS e mortalidade.<br />Enchimento ventricular sub ótimo<br />Piora da duração e gravidade da insuficiência mitral<br />Desvioparadoxal do SIV<br />Maior Volume Sistólico Final<br />MenorDébitocardíaco e fração de ejeção.<br />Maiormortalidade.<br />30 – 50% dos pacientes com IC avançada tem BRE - Preditor de maiormortalidade.<br />TRC<br />
    3. 3. Benefícios TRC<br />Melhoracaminhada 6 minutos<br />Melhoraqualidade de vida<br />Aumenta DC sempiorarconsumo de O2<br />Diminuiinternacoespor IC descompensadaemtorno de 30%<br />MelhoraClasseFuncional NYHA<br />MelhoraFração de Ejeção.<br />Menormortalidadeemtorno de de 25 – 35%.<br />TRC<br />Epstein et al. ACC/AHA/HRS Guidelines for Device-Based Therapy<br />Circulation. 2008;117:e350-e408.<br />
    4. 4. Benefícios TRC<br />Tempo da respostaà TRC:<br />A ressincronizaçãoocorreimediatamenteapósimplantação do MP biventricular.<br />A reversão do remodelamentocardíacoéesperadoem 6 meses.<br /> MIRACLE trial: benefíciosalcançadosem 1 mês.<br />CARE-HF e COMPANION: benefíciosalcançadosempelomenos 3 meses.<br />TRC<br />
    5. 5. Cronologia.<br />TRC<br />AHA Guide<br />2008<br />1994: Cazeau, et al <br />MP Tetracamara<br />Melo CS, Lucatto LFA. Histórico sobre a terapia de ressincronização cardíaca. <br />Reblampa2006; 19(1): 25-28.<br />
    6. 6. Indicações TRC<br />CF III – IV NYHA<br />QRS ≥ 120ms com dissincroniaao Eco ou QRS ≥ 150ms<br />Disfunçãosistólica FE ≤ 35% isquêmicaounão.<br />TerapiamedicamentosaotimizadaparaIC porpelomenos 3 mesesincluindodiuréticos.<br />TRC<br />
    7. 7. CARE – HF Trial<br />TRC<br />Resultados:<br /><ul><li>Diminuição End Point primário (39% vs 55%).
    8. 8. Reduçãomortalidadeemtorno de 36%
    9. 9. Melhorana FE
    10. 10. Queda no BNP
    11. 11. Melhorqualidade de vida
    12. 12. Melhora no remodelamentocardíaco.</li></ul>Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiacREsynchronization-Heart Failure<br />European Heart Journal (2006)<br />
    13. 13. META ANÁLISE2007<br />Cardiac Resynchronization Therapy For Patients With Left Ventricular Systolic Dysfunction: A Systematic Review.JAMA. 2007;297(22):2502<br />Feita com 14 trials randomizados e controlados.<br />MelhorQualidade de Vida e CF NYHA<br />Menornumero de Internações<br />Menormortalidade.<br />TRC<br />
    14. 14. Recommendations for Cardiac Resynchronization Therapy in Patients With Severe Systolic Heart Failure<br />ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities<br />
    15. 15. Recommendations for Cardiac Resynchronization Therapy in Patients With Severe Systolic Heart Failure<br />ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities<br />

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