Tournoux Francois B, Alabiad Chrisfouad, Fan Dali, Chen Annabel A, Chaput Miguel, Heist Edwin Kevin, Mela Theofanie, Mansour Moussa, Reddy Vivek, Ruskin Jeremy N, Picard Michael H, Singh Jagmeet P
Cardiac Arrhythmia Service and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Eur Heart J. 2007 May;28(9):1143-8. doi: 10.1093/eurheartj/ehm050. Epub 2007 Apr 21.
Although acute haemodynamic improvement in response to cardiac resynchronization therapy (CRT) is reflective of a favourable cardiac contractile response, there is limited information regarding not only its ability to predict long-term clinical outcome but also cardiac-substrate-specific differences in the prognostic value of this measure.
Fifty-three heart failure patients (69 +/- 11 years) with low left ventricle ejection fraction (LVEF) (22 +/- 6%), wide QRS (169 +/- 31 ms), and indications for CRT were included. There were no significant differences in age, New York Heart Association (NYHA) class, medications, QRS width, or LVEF between ischaemic (n = 37) and non-ischaemic (n = 16) groups. Echocardiograms were performed within 24 h of implantation with device OFF and ON. Acute haemodynamic response was measured as LV dP/dt derived from the CW Doppler of mitral regurgitation. Percentage change in dP/dt was used to classify patients: high- (HR: DeltadP/dt > 25%) or poor-responders (PR: DeltadP/dt <or= 25%). Clinical response to CRT was defined by a combined endpoint of hospitalizations and all-cause mortality at 12 months. HR group had a significantly better outcome compared to the PR group (P-value = 0.004) irrespective of the aetiology of the cardiomyopathy.
Echocardiographic assessment of the acute haemodynamic response to CRT predicts long-term clinical outcome in both ischaemic and non-ischaemic cardiomyopathy.
尽管心脏再同步治疗（CRT）引起的急性血流动力学改善反映了良好的心脏收缩反应，但关于其预测长期临床结局的能力以及该指标在不同心脏底物中的预后价值差异的信息有限。
纳入53例左心室射血分数（LVEF）低（22±6%）、QRS波增宽（169±31毫秒）且有CRT指征的心力衰竭患者（69±11岁）。缺血性心肌病组（n = 37）和非缺血性心肌病组（n = 16）在年龄、纽约心脏协会（NYHA）心功能分级、用药情况、QRS波宽度或LVEF方面无显著差异。在植入装置开启和关闭状态下，于植入后24小时内进行超声心动图检查。急性血流动力学反应通过二尖瓣反流的连续波多普勒测得的左心室dp/dt来衡量。dp/dt的变化百分比用于对患者进行分类：高反应者（HR：Δdp/dt>25%）或低反应者（PR：Δdp/dt≤25%）。CRT的临床反应通过12个月时的住院和全因死亡率综合终点来定义。无论心肌病的病因如何，HR组的结局均显著优于PR组（P值 = 0.004）。
超声心动图评估CRT的急性血流动力学反应可预测缺血性和非缺血性心肌病的长期临床结局。
