Adamson Philip B., Abraham William T.
Departments of Medicine, Cardiology, and Physiology, University of Oklahoma Health Sciences Center, P.O. Box 26901, 920 S.L. Young Boulevard, WP3120, Oklahoma City, OK 73190, USA.
Curr Treat Options Cardiovasc Med. 2003 Aug;5(4):301-309. doi: 10.1007/s11936-003-0029-5.
Cardiac resynchronization therapy (CRT) represents a new class of heart failure therapy that provides symptom relief and decreased need of hospitalization in a significant number of patients already receiving maximal medical intervention. Patients with ischemic or nonischemic dilated cardiomyopathy, coupled with interventricular conduction delays, who have New York Heart Association class III or IV symptoms, are currently candidates for CRT. This device-based intervention reverses adverse ventricular remodeling, decreases the severity of mitral regurgitation, and increases cardiac efficiency and output. New selection criteria are being considered in an attempt to identify patients who have a high chance of responding, and possibly, to identify patients that have a high chance of not responding to CRT. These efforts are in response to the 20% to 25% "nonresponder" rate observed when the currently accepted inclusion criteria are used. Other patient populations may also benefit from CRT, including those in need of antibradycardia pacing, patients with atrial fibrillation, and some who meet the criteria for prophylactic implantation of a cardiac defibrillator. This review focuses on the current strategies to refine patient selection criteria and addresses some of the practical issues in prescribing CRT.
心脏再同步治疗（CRT）是一类新型的心力衰竭治疗方法，对于大量已接受最大程度药物干预的患者而言，它能缓解症状并减少住院需求。患有缺血性或非缺血性扩张型心肌病且伴有心室传导延迟、纽约心脏协会心功能分级为III级或IV级症状的患者，目前是CRT的适用对象。这种基于设备的干预措施可逆转不良的心室重塑，减轻二尖瓣反流的严重程度，并提高心脏效率和输出量。目前正在考虑新的选择标准，以试图识别出有高反应几率的患者，并且有可能识别出对CRT无反应几率高的患者。这些努力是为了应对在使用当前公认的纳入标准时观察到的20%至25%的“无反应者”率。其他患者群体也可能从CRT中获益，包括那些需要抗心动过缓起搏治疗的患者、心房颤动患者以及一些符合心脏除颤器预防性植入标准的患者。本综述重点关注优化患者选择标准的当前策略，并探讨了开具CRT处方时的一些实际问题。
