Van Hemel N M
Utrecht University, Heart Lung Centre Utrecht, Utrecht, NL.
Minerva Cardioangiol. 2007 Dec;55(6):783-802.
Electrical cardiac resynchronization therapy (CRT) with biventricular pacing improves the impaired left ventricular function in selected patients and reduces mortality, morbidity and the number of hospitalizations for heart failure. Reversed left ventricular remodelling following CRT has been documented by various imaging
Application of CRT involves many factors as selection, implantation procedure, pacing site, programming of the atrioventricular and interventricular pacing intervals, optimal medical and anti-arrhythmic treatment and counselling of the patient with congestive heart failure (CHF). The contribution of various components of CRT to the hemodynamic response and to the left and right ventricular function has been extensively documented. Large prospective studies also demonstrated improvement of health related quality of life (QoL) compared to control patients. The cost-effectiveness of CRT and CRT/implantable cardioverter defibrillators (ICD) in terms of quality adjusted life year appears satisfying provided life expectancy of the recipient is enlarged. However, the follow up of most studies is rather short and QoL is always compared with the baseline condition. Furthermore, the clinical relevance of the reported numerical improvement of QoL and its persistence are fully unknown. The individual improvement of QoL of the CRT recipient cannot be predicted from clinical variables. Literature shows that the contribution of the various CRT factors to the hemodynamic response and to the left and right ventricular function and clinical benefit are extensively studied but not their contribution to health related QoL. For this purpose the contribution to QoL of all factors that are related to CRT response, was stepwise reviewed. Literature showed for several reasons no clear association with any individual CRT component and QoL. It can be concluded that prospective serial QoL studies of CRT patients in conjunction with studies of the cardiac function are requested to identify not only the contribution of CRT factors to QoL but also (sub)groups that benefit most. In these trials the methods and relevance of regular re-examination of the left ventricular function and of reprogramming of the device parameters to obtain a sustained positive CRT responsiveness, need to be established. Finally, because CRT has become a multidisciplinary therapy for chronic heart failure, the professional influence on QoL of the CRT recipient has to be studied.
双心室起搏的心脏电再同步治疗（CRT）可改善部分患者受损的左心室功能，并降低死亡率、发病率以及心力衰竭住院次数。多种成像方法已证实CRT后左心室逆向重构。
CRT的应用涉及诸多因素，如患者选择、植入程序、起搏部位、房室和室间起搏间期的程控、对充血性心力衰竭（CHF）患者的最佳药物及抗心律失常治疗以及咨询。CRT各组成部分对血流动力学反应以及左右心室功能的作用已有大量文献记载。大型前瞻性研究还表明，与对照组患者相比，健康相关生活质量（QoL）有所改善。就质量调整生命年而言，CRT和CRT/植入式心脏复律除颤器（ICD）的成本效益似乎令人满意，前提是接受者的预期寿命得以延长。然而，大多数研究的随访时间较短，且QoL总是与基线状况进行比较。此外，所报道的QoL数值改善的临床相关性及其持续性完全未知。无法根据临床变量预测CRT接受者QoL的个体改善情况。文献表明，对CRT各因素对血流动力学反应、左右心室功能及临床益处的作用已进行了广泛研究，但未研究其对健康相关QoL的作用。为此，对与CRT反应相关的所有因素对QoL的作用进行了逐步综述。文献显示，由于多种原因，与任何单个CRT组成部分和QoL均无明确关联。可以得出结论，需要对CRT患者进行前瞻性系列QoL研究，并结合心脏功能研究，不仅要确定CRT因素对QoL的作用，还要确定受益最大的（亚）组。在这些试验中，需要确定定期重新检查左心室功能以及重新程控设备参数以获得持续积极的CRT反应性的方法和相关性。最后，由于CRT已成为慢性心力衰竭的多学科治疗方法，必须研究CRT接受者的专业因素对QoL的影响。
