Pitzalis Maria Vittoria, Iacoviello Massimo, Romito Roberta, Guida Pietro, De Tommasi Elisabetta, Luzzi Giovanni, Anaclerio Matteo, Forleo Cinzia, Rizzon Paolo
Institute of Cardiology, University of Bari, Bari, Italy.
J Am Coll Cardiol. 2005 Jan 4;45(1):65-9. doi: 10.1016/j.jacc.2004.09.058.
The aim of this study was to evaluate whether the clinical benefit of cardiac resynchronization therapy (CRT) can be prospectively predicted by means of the baseline evaluation of left ventricular asynchrony.
The reverse remodeling associated with CRT is more evident in patients with severe heart failure (HF) and left bundle branch block (LBBB) who have left ventricular asynchrony.
Baseline left ventricular asynchrony was assessed in 60 patients with severe HF and LBBB by calculating the electrocardiographic duration of QRS and the echocardiographic septal-to-posterior wall motion delay (SPWMD). Left ventricular size and left ventricular ejection fraction (LVEF), mitral valve regurgitation, and functional capacity were also evaluated. The progression toward HF (defined as a worsening clinical condition leading to a sustained increase in conventional therapies, hospitalization, cardiac transplantation, and death) was assessed during follow-up, as were the changes in LVEF after six months.
During the median follow-up of 14 months, 16 patients experienced HF progression. Univariate analysis showed that ischemic cardiomyopathy, changes in the QRS duration after implantation, and SPWMD significantly correlated with events. At multivariate analysis, a long SPWMD remained significantly associated with a reduced risk of HF progression (hazard ratio: 0.91; 95% confidence interval: 0.83 to 0.99; p <0.05). An improvement in LVEF was observed in 79% of the patients with a baseline SPWMD of > or =130 ms and in 9% of those with an SPWMD of <130 ms (p <0.0001).
Baseline SPWMD is a strong predictor of long-term clinical improvement after CRT in patients with severe HF and LBBB.
本研究旨在评估通过左心室不同步的基线评估能否前瞻性预测心脏再同步治疗（CRT）的临床益处。
与CRT相关的逆向重构在患有左心室不同步的严重心力衰竭（HF）和左束支传导阻滞（LBBB）患者中更为明显。
通过计算心电图QRS时限和超声心动图测量室间隔与后壁运动延迟（SPWMD），对60例严重HF和LBBB患者的基线左心室不同步进行评估。还评估了左心室大小、左心室射血分数（LVEF）、二尖瓣反流和心功能。随访期间评估向HF进展情况（定义为临床状况恶化导致传统治疗持续增加、住院、心脏移植和死亡），以及6个月后LVEF的变化。
在中位随访14个月期间，16例患者出现HF进展。单因素分析显示，缺血性心肌病、植入后QRS时限变化和SPWMD与事件显著相关。多因素分析时，长SPWMD仍与HF进展风险降低显著相关（风险比：0.91；95%置信区间：0.83至0.99；p<0.05）。基线SPWMD≥130 ms的患者中79%的LVEF有所改善，而SPWMD<130 ms的患者中这一比例为9%（p<0.0001）。
基线SPWMD是严重HF和LBBB患者接受CRT后长期临床改善的有力预测指标。
