Диссинхрония миокарда и факторы риска внезапной кардиальной смерти у больных с хронической сердечной недостаточностью

Objective: To study the relationship between mechanical dyssynchrony assessed by echocardiography and the criteria for high risk of sudden cardiac death in patients with congestive heart failure (CHF). Material and methods: The study involved 162 patients with CHF (143 males and 19 females, mean age 57±10 years), among whom 118 (73%) patients had diagnosis of coronary artery disease (CAD) and 44 (27%) patients had non-ischemic cardiomyopathy. In all patients, LV ejection fraction (LV EF) decreased by <35% or <35-45% when life-threatening ventricular arrhythmias occurred. The following parameters of risk factors were estimated: CHF NYHA functional class; left bundle branch block (LBBB); ventricular tachycardia (VT); LV EF. Results: According to the results of echocardiography, signs of dyssynchrony were observed in 35% (56 out of 162) patients, while the frequency of dyssynchrony detection in non-ischemic cardiomyopathy was 50 and 29% (p<0.01) in CAD. LBBB was observed significantly more often in patients with signs of dyssynchrony (48 and 8%, p<0.001), regardless of diagnosis. There was no relationship between VT and dyssynchrony. LV EF was 30±5% in the presence and 32±5% (p<0.05) in the absence of dyssynchrony signs. In patients with non-ischemic cardiomyopathy, LV EF was 29±5% in the presence of dyssynchrony and 35±5% (p<0.01) in the absence of dyssynchrony. No significant differences in LV EF were found in the group of patients with cAd. Conclusions: Myocardial dyssynchrony was associated with LBBB in all patients and with decrease in LV EF only in the group of non-ischemic cardiomyopathy. Associations between dyssynchrony and VT as well as NYHA functional class were not detected.