Jansen Annemieke H M, Bracke Frank, van Dantzig Jan Melle, Peels Kathinka H, Post Johannes C, van den Bosch Harrie C M, van Gelder Berry, Meijer Albert, Korsten Hendrikus H M, de Vries Jolanda, van Hemel Norbert M
Department of Cardiology, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Eur J Echocardiogr. 2008 Jul;9(4):483-8. doi: 10.1016/j.euje.2007.07.002. Epub 2007 Sep 10.
The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT.
Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as >/=10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5-151.9; P = 0.004) independently predicted LV reverse remodeling.
In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.
研究透壁瘢痕的位置和范围及其与心脏再同步治疗（CRT）中不同步的关系，因为后外侧瘢痕组织被认为是CRT无反应的原因。
对57例符合CRT标准的患者进行钆增强磁共振成像评估透壁瘢痕，并采用组织多普勒评估左心室（LV）不同步。植入后，优化房室和室间起搏间期。LV逆向重构定义为3个月后LV收缩末期容积减少≥10%。16例患者在后外侧（PL）区域（LV导联位置）有透壁瘢痕，14例在远离该区域（非PL）有瘢痕，27例患者无瘢痕。LV逆向重构分别见于25%、64%和89%的患者（P = 0.0001）。单因素分析显示与LV不同步（P = 0.004）和无PL瘢痕（P = 0.04）有关，但与QRS时限和LV瘢痕组织范围无关。多因素分析中，只有LV不同步（OR：19.62；95% CI：2.5 - 151.9；P = 0.004）独立预测LV逆向重构。
在本研究中，即使存在后外侧瘢痕，只要房室和室间起搏间期得到优化，LV不同步仍然是CRT反应的最重要决定因素。
