Arzola-Castaner Daniel, Taub Cynthia, Kevin Heist E, Fan Dali, Haelewyn Kyle, Mela Theofanie, Picard Michael H, Ruskin Jeremy N, Singh Jagmeet P
Cardiac Arrhythmia Service, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Cardiovasc Electrophysiol. 2006 Jun;17(6):623-7. doi: 10.1111/j.1540-8167.2006.00480.x.
Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT.
A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt (%DeltadP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being "on" (group 1) or "off" (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %DeltadP/dt 48.8 +/- 67.4% vs group 2 [n = 24]; %DeltadP/dt 32.2 +/- 40.1%, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, %DeltadP/dt 45.7 +/- 50.7% and ML, %DeltadP/dt 45.1 +/- 58.8% vs AL, %DeltadP/dt 2.9 +/- 30.9%, respectively, P = 0.014).
LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.
既往研究报告称，心脏再同步治疗（CRT）的最佳起搏部位位于左心室（LV）侧壁和后外侧（PL）壁。然而，关于在运动不能部位进行起搏是否会影响CRT的收缩反应和长期预后，目前知之甚少。
共对38例缺血性心肌病患者进行了研究，观察其对CRT的急性血流动力学反应和12个月的临床反应。通过二尖瓣反流（MR）多普勒频谱，在开启和关闭CRT的情况下，得出个体dP/dt相对于基线的百分比变化（%ΔdP/dt）。使用二维超声心动图进行心肌分割并确定运动不能部位。根据血管造影和影像学数据确定LV导联植入部位，并分为位于运动不能部位“之上”（第1组）或“之外”（第2组）。将心力衰竭住院和/或12个月时的全因死亡率作为综合终点来衡量长期反应。采用Kaplan-Meier法估计至主要终点的时间。两组的临床特征和急性血流动力学反应相似（第1组[n = 14]；%ΔdP/dt为48.8±67.4%，第2组[n = 24]；%ΔdP/dt为32.2±40.1%，P = 0.92）。未观察到长期预后的差异（P = 0.59）。相比之下，与前外侧（AL）位置相比，将导联置于PL或中外侧（ML）位置时，急性血流动力学反应更好（PL组%ΔdP/dt为45.7±50.7%，ML组%ΔdP/dt为45.1±58.8%，而AL组%ΔdP/dt为2.9±30.9%，P = 0.014）。
LV导联靠近运动不能节段并不影响CRT的急性血流动力学或12个月临床反应。
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