Soliman Osama I I, Geleijnse Marcel L, Theuns Dominic A M J, Nemes Attila, Vletter Wim B, van Dalen Bas M, Motawea Ahmed K, Jordaens Luc J, ten Cate Folkert J
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2008 Mar 1;101(5):651-7. doi: 10.1016/j.amjcard.2007.10.027. Epub 2008 Feb 21.
Patients with heart failure and mechanical dyssynchrony suffer a progressive increase in left ventricular (LV) mass and asymmetrical regional hypertrophy with eventual poor prognosis. The present study sought to investigate whether cardiac resynchronization therapy (CRT) could reverse these abnormalities. The study included 66 consecutive heart failure patients who received CRT. All patients underwent serial evaluation before, 3 months after, and 12 months after CRT. At 12 months after CRT, 50 patients (76%) were echocardiographic volumetric responders, defined as a >15% reduction in LV end-systolic volume. LV end-systolic volume was decreased from 214 +/- 97 ml to 179 +/- 88 ml at 3 months and was further decreased to 158 +/- 86 ml at 12 months after CRT (all p <0.01). LV ejection fraction was improved from 18% +/- 4% to 28% +/- 7% (p <0.001) at 3 months without further change at 12 months after CRT. LV mass was reduced from 242 +/- 52 g to 222 +/- 45 g at 3 months and was further reduced to 206 +/- 50 g at 12 months after CRT (all p <0.01). Improvement of LV geometry was seen as improvements of the end-diastolic (1.64 +/- 0.14 vs 1.77 +/- 0.17, p <0.001) and the end-systolic (1.63 +/- 0.14 vs 1.99 +/- 0.22, p <0.001) sphericity indexes, respectively, at 3 months, without further significant changes at 12 months after CRT. Volumetric responders had a reduction in LV mass from 240 +/- 50 to 210 +/- 38 at 3 months, and LV mass was further reduced to 186 +/- 37 g at 12 months after CRT (all p <0.01). In contrast, nonresponders had a progressive increase in LV mass from 248 +/- 59 g to 258 +/- 54 g at 3 months, and LV mass was further increased to 269 +/- 60 g at 12 months after CRT (all p <0.05). Likewise, only in volumetric responders, regression of the asymmetric hypertrophy of the lateral wall was noted. In conclusion, CRT results in not only volumetric improvement but also in true reverse LV structural remodeling, evidenced by progressive reduction in LV mass and restoration of regional wall symmetry.
心力衰竭合并机械性不同步的患者左心室（LV）质量会逐渐增加，出现不对称性局部肥厚，最终预后不良。本研究旨在调查心脏再同步治疗（CRT）是否能逆转这些异常情况。该研究纳入了66例连续接受CRT治疗的心力衰竭患者。所有患者在CRT治疗前、治疗后3个月和治疗后12个月均接受了系列评估。在CRT治疗后12个月时，50例患者（76%）为超声心动图容积反应者，定义为LV收缩末期容积减少>15%。CRT治疗后3个月时，LV收缩末期容积从214±97 ml降至179±88 ml，12个月时进一步降至158±86 ml（所有p<0.01）。CRT治疗后3个月时，LV射血分数从18%±4%提高到28%±７%（p<0.001），12个月时无进一步变化。CRT治疗后3个月时，LV质量从242±52 g降至222±45 g，12个月时进一步降至206±50 g（所有p<0.01）。LV几何形状的改善表现为舒张末期（1.64±0.14对1.77±0.17，p<0.001）和收缩末期（1.63±0.14对1.99±0.22，p<0.001）球形指数分别在3个月时得到改善，CRT治疗后12个月无进一步显著变化。容积反应者在CRT治疗后3个月时LV质量从240±50降至210±38，12个月时LV质量进一步降至186±37 g（所有p<0.01）。相比之下，无反应者在CRT治疗后3个月时LV质量从248±59 g逐渐增加到258±54 g，12个月时LV质量进一步增加到269±60 g（所有p<0.05）。同样，仅在容积反应者中观察到侧壁不对称肥厚的消退。总之，CRT不仅能改善容积，还能真正逆转LV结构重塑，表现为LV质量逐渐降低和局部壁对称性恢复。
