Ypenburg Claudia, Roes Stijntje D, Bleeker Gabe B, Kaandorp Theodorus A M, de Roos Albert, Schalij Martin J, van der Wall Ernst E, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2007 Mar 1;99(5):657-60. doi: 10.1016/j.amjcard.2006.09.115. Epub 2007 Jan 4.
It was shown that improvement in left ventricular (LV) function and reverse remodeling after cardiac resynchronization therapy (CRT) were greater in patients with nonischemic cardiomyopathy than in those with ischemic cardiomyopathy. The aim of this study is to evaluate the influence of scar burden on response to CRT. We included 34 patients with ischemic cardiomyopathy (New York Heart Association class 3.1 +/- 0.4, LV ejection fraction 23 +/- 7%). Contrast-enhanced magnetic resonance imaging was used to determine total scar burden, using a 17-segment model with a 5-point hyperenhancement scale (from score 0 = no hyperenhancement, indicating no scar, to score 4 = hyperenhancement >76%, transmural scar). Linear regression analysis showed a significant correlation (r = -0.91, p <0.05) between total scar burden at baseline and change in LV end-systolic volume after 6 months of CRT. Also, patients not responding to CRT had significantly more scar tissue than responders. A scar burden >1.20 resulted in complete functional nonresponse. In conclusion, total scar burden, assessed using contrast-enhanced magnetic resonance imaging, is an important factor influencing response to CRT and may be included in the selection process for CRT candidates.
研究表明，心脏再同步治疗（CRT）后，非缺血性心肌病患者左心室（LV）功能的改善及逆向重构程度大于缺血性心肌病患者。本研究旨在评估瘢痕负荷对CRT反应的影响。我们纳入了34例缺血性心肌病患者（纽约心脏协会心功能分级3.1±0.4，左心室射血分数23±7%）。采用对比增强磁共振成像，使用17节段模型及5分强化程度量表（从0分=无强化，即无瘢痕，到4分=强化>76%，透壁瘢痕）来确定总瘢痕负荷。线性回归分析显示，基线时的总瘢痕负荷与CRT治疗6个月后左心室收缩末期容积的变化之间存在显著相关性（r = -0.91，p <0.05）。此外，对CRT无反应的患者瘢痕组织明显多于有反应的患者。瘢痕负荷>1.20会导致完全无功能反应。总之，使用对比增强磁共振成像评估的总瘢痕负荷是影响CRT反应的重要因素，可能应纳入CRT候选者的选择过程中。
