A retrospective study involving 40 patients, based on the initial division of the patients into 2 groups: group I (N = 20) - high response to cardiac resynchronization therapy (CRT) and group II (N = 20) - lack of response to CRT. Criteria of CRT efficacy were: decrease in end-systolic left ventricular volume equal to or more than 15 %, relative increase in left ventricular ejection fraction equal to or greater than 10 %, decrease in functional class of chronic heart failure (NYHA) equal to 1 or greater. Low response of CRT was determined as the absence of criteria said above (the lack of positive dynamics in left ventricle diameters and volumes, ejection fraction, or it had a negative value in the form of further enlargement of the heart chambers and the reduction of its contractile capacity). The initial patient separation by the degree of response to cardiac resynchronization therapy suggests verification the hypothesis that a different response to CRT may be associated with the relative position of the ventricle electrodes and the parameters of ventricular myocardial dyssynchrony.

Objective. To study possibilities of non-invasive electrophysiological mapping (NEM) in assessment of dependence of cardiac resynchronization effect from the position of the left ventricular electrode (LVE). Design and methods. NEM was performed on 24 patients, utilizing the «Amycard 01C EP LAB». Position of the stimulation LVE pole was estimated on the segmental epicardial ventricular model; and the epicenter of the late activation area of the left ventricular (LV) with complete left bundle branch block (LBBB) was determined. Also the interventricular electrode distance was measured. Results. The epicenter of the late zone on LBBB most frequently was determined in the basal area on the border of the posterior and lateral walls of the LV - 42 % (n = 10). In patients with response to cardiac resynchronization therapy (CRT) the distance (LVE pole - the epicenter of the epicardial late activation area of the LV on LBBB) was not significantly greater than the width of the LV segment. The smallest interventricular electrode distance of 49 mm was found in patient without response to CRT. Conclusion. Using NEM, one may accurately measure the distance between the stimulating poles of ventricular electrodes and the distance from the stimulating LVE pole to the epicenter of the epicardial late activation area of the LV on LBBB. The CRT effect is clearer if the distance between LVE and late zone is not significantly greater than the width of one LV segment.

The aim of the study was to provide comparative analysis of the zones with maximum intraventricular myocardial dyssynchrony (IVD) and the localizations of ventricular electrodes in patients with differential responses to cardiac resynchronization therapy (CRT). Materials and Methods: Retrospective study comprised patients (n=40) who had sinus rhythm, complete left bundle branch block (LBBB), left ventricular (LV) ejection fraction (EF) 15%, relative increase of LV eF ≥10%), and group 2 (n=20) with insufficient response to CRT (the absence of dynamics in the sizes, volumes, and LV EF). For topical evaluation of the zone of stimulation with ventricular electrode, a vector analysis of ECG was performed in the beginning and the end of the follow up period (VL was divided in 12 segments, RV was divided in 3 segments). Intraventricular and interventricular dyssynchrony of the myocardium was detected by echocardiography with tissue Doppler sonography. Results: initially, the groups did not differ in regard to gender, age, and parameters of echocardiography with tissue Doppler sonography. The absence of initial IVD was observed in 7 patients of group 1 and in 8 patients of group 2, p = 0.503, cardiomyopathy of ischemic genesis significantly prevailed in group 2 (75%, n=15, р=0.014). Dislocation of the leads was not documented for the entire period of the study, displacement of LV electrodes within the vein of the coronary sinus occurred in three cases. The final sizes, volumes, and LV EF values differed between the groups (р < 0.001), mean LV EF was 44.9±5.9% in group 1 and 26.9±6.4% in group 2. Overlapping of maximum IVD zone with the site of LV electrode implantation was more significant in group 1, р = 0.028. Final values of IVD were within normal ranges in both groups, the absence of IVD was observed in 95% and 80% of patients in group 1 and group 2, respectively, р = 0.493. Conclusions: correspondence of the myocardial zone with maximum dyssynchrony to the site of the Lv lead implantation was associated with a high response to CRT in the long term. Insufficient response can be caused by a non-optimal positioning of the LV electrode, lack of agreement between implantation site and IVD zone, and by positions of the ventricular electrodes close to each other.

Objective. Analysis based on RUssian hoSpital Heart Failure Registry (RUS-HFR) etiology of systolic CHF, cause of hospitalization of these patients and compliance their therapy with international recommendations in 3 subjects of the RF. Design and methods. The RUS-HFR is a prospective, multicentre, observational study conducted in 3 Cardiology Centers (St. Petersburg - the central coordinator of the project, Samara, Orenburg). Inclusion criteria were CHF NYHA I-IV functional classes, LVEF<40 %, age 18-75 years, the absence of current myocardial infarction and pulmonary embolism. Results. From October 2012 to Jun 2013, 251 patients were enrolled, the mean age of the patients was 60 years and 79 % were men. Main etiologies were ischemic heart disease and hypertension. Ratio causes of hospitalization, its duration varied depending on the profile and capabilities of hospitals. conclusion. Compared with 10 years ago in Russia, in general a «portrait» of a patient with systolic heart failure has not changed, however, increased the proportion of patients undergoing cardiac surgery, and the percentage of patients receiving RAS blockers, P-AB, MRAs today compares with European registers. The greatest number of inconsistencies recommendations for mandatory drug therapy is detected in patients with CHF functional class II. Diuretic therapy is not prescribed for clinically expressed HF in 20-35 % of cases. High-tech methods of treatment in CHF patients (NYHA II-IV) in hospitals participating RUS-HFR recommend not often enough. «Planned» hospitalization (requiring correction of drug therapy) is 12-36 % of cases, and their duration was significantly higher than in the EU and USA.