Tedrow Usha B, Kramer Daniel B, Stevenson Lynne W, Stevenson William G, Baughman Kenneth L, Epstein Laurence M, Lewis Eldrin F
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Cardiol. 2006 Jun 15;97(12):1737-40. doi: 10.1016/j.amjcard.2006.01.033. Epub 2006 Apr 24.
The degree to which increased right-sided heart pressures influence outcome in cardiac resynchronization therapy (CRT) is unclear. High right ventricular (RV) pressures may contribute to septal malpositioning, thus hindering effective resynchronization. We hypothesized that patients with high RV systolic pressures before CRT implantation would have poorer outcome. We evaluated echocardiograms, electrocardiograms, and clinical records from 75 consecutive patients with CRT. RV systolic pressure was calculated from the peak tricuspid regurgitant, time-velocity profile. The primary end point was a composite of mortality, cardiac transplantation, or need for a left ventricular assist device. Events were evaluated by Kaplan-Meier curves and Cox proportional hazard ratios. Patients grouped by RV systolic pressure divided at the median of 35 mm Hg were similar except for more renal insufficiency and RV dysfunction when RV systolic pressure was >35 mm Hg. Univariate analysis identified RV systolic pressure >35 mm Hg (hazard ratio [HR] 3.32), diabetes (HR 2.45), renal insufficiency (HR 3.52), atrial fibrillation (HR 3.07), use of nonamiodarone antiarrhythmic medications (HR 2.86), atrial pacing (HR 2.57), and prolonged PR interval (HR 1.009) as associated with poorer outcome. Normal sinus rhythm at implantation (HR 0.34), baseline left bundle branch block (HR 0.44), and beta-blocker use (HR 0.47) were associated with improved outcome. In a multivariable model, high RV systolic pressure (HR 3.71, 95% confidence interval 1.31 to 10.4), renal insufficiency (HR 3.18, 95% confidence interval 1.29 to 7.86), and atrial fibrillation (HR 4.22, 95% confidence interval 1.54 to 11.6) remained significant. In conclusion, despite resynchronization, patients with high RV pressures have significantly decreased survival after adjusting for significant contributing influences.
右侧心脏压力升高对心脏再同步治疗（CRT）结局的影响程度尚不清楚。高右心室（RV）压力可能导致室间隔位置异常，从而阻碍有效的再同步。我们假设，CRT植入前右心室收缩压高的患者结局较差。我们评估了75例连续接受CRT治疗患者的超声心动图、心电图和临床记录。右心室收缩压根据三尖瓣反流峰值、时间-速度曲线计算得出。主要终点是死亡、心脏移植或需要左心室辅助装置的复合终点。通过Kaplan-Meier曲线和Cox比例风险比评估事件。按右心室收缩压在35 mmHg中位数处进行分组的患者，除右心室收缩压>35 mmHg时肾功能不全和右心室功能障碍更多外，其他情况相似。单因素分析确定，右心室收缩压>35 mmHg（风险比[HR] 3.32）、糖尿病（HR 2.45）、肾功能不全（HR 3.52）、心房颤动（HR 3.07）、使用非胺碘酮抗心律失常药物（HR 2.86）、心房起搏（HR 2.57）和PR间期延长（HR 1.009）与较差的结局相关。植入时窦性心律正常（HR 0.34）、基线左束支传导阻滞（HR 0.44）和使用β受体阻滞剂（HR 0.47）与较好的结局相关。在多变量模型中，高右心室收缩压（HR 3.71，95%置信区间1.31至10.4）、肾功能不全（HR 3.18，95%置信区间1.29至7.86）和心房颤动（HR 4.22，95%置信区间1.54至11.6）仍然具有显著性。总之，尽管进行了再同步治疗，但在调整显著的影响因素后，右心室压力高的患者生存率显著降低。
