Piepoli Massimo F, Villani Giovanni Q, Corrà Ugo, Aschieri Daniela, Rusticali Guido
Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital, Piacenza, Italy.
Pacing Clin Electrophysiol. 2008 Jun;31(6):701-8. doi: 10.1111/j.1540-8159.2008.01073.x.
To assess in patients with chronic heart failure the effect of cardiac resynchronization therapy (CRT) over 12 months' follow-up the time course of the changes in functional and neurohormonal indices and to identify responders to CRT.
Eighty-nine patients (74.1 +/- 1 years, left ventricular ejection fraction [LVEF] < 35%), QRS complex duration >150 ms, in stable New York Heart Association (NYHA) class III or IV on optimal medical treatment were prospectively randomized either in a control (n = 45) or CRT (n = 44) group and underwent clinical evaluation, cardiopulmonary exercise testing (CPET), 2D-Echo, heart rate variability (HRV), carotid baroreflex (BRS), and BNP assessments before and at 6- and 12-month follow-up.
In the CRT group, improvement of cardiac indices and BNP concentration were evident at medium term (over 6 months) follow-up, and these changes persisted on a longer term (12 months) (all P < 0.05). Instead CPET indices and NYHA class improved after 12 months associated with restoration of HRV and BRS (all P < 0.05). We identified 26 responders to CRT according to changes in LVEF and diameters. Responders presented less depressed hemodynamic (LVEF 25 +/- 1.0 vs 22 +/- 0.1%), functional (peak VO(2) 10.2 +/- 0.2 vs 6.9 +/- 0.3 ml/kg/min), and neurohormonal indices (HRV 203.6 +/- 15.7 vs 147.6 +/- 10.ms, BRS 4.9 +/- 0.2 vs 3.6 +/- 0.3 ms/mmHg) (all P < 0.05). In the multivariate analysis, peak VO(2) was the strongest predictor of responders.
Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO(2)) was the strongest predictor of responders to CRT.
评估慢性心力衰竭患者接受心脏再同步治疗（CRT）12个月随访期间功能和神经激素指标变化的时间进程，并确定CRT的反应者。
89例患者（年龄74.1±1岁，左心室射血分数[LVEF]<35%），QRS波时限>150ms，纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级且接受最佳药物治疗病情稳定，前瞻性随机分为对照组（n = 45）或CRT组（n = 44），并在基线、6个月和12个月随访时进行临床评估、心肺运动试验（CPET）、二维超声心动图、心率变异性（HRV）、颈动脉压力反射（BRS）和脑钠肽（BNP）评估。
在CRT组，中期（超过6个月）随访时心脏指标和BNP浓度明显改善，且这些变化在长期（12个月）持续存在（所有P<0.05）。相反，12个月后CPET指标和NYHA心功能分级改善，与HRV和BRS恢复相关（所有P<0.05）。根据LVEF和内径变化，我们确定了26例CRT反应者。反应者的血流动力学（LVEF 25±1.0%对22±0.1%）、功能（峰值VO₂ 10.2±0.2对6.9±0.3ml/kg/min）和神经激素指标（HRV 203.6±15.7对147.6±10.ms，BRS 4.9±0.2对3.6±0.3ms/mmHg）受抑制程度较轻（所有P<0.05）。多因素分析中，峰值VO₂是反应者最强的预测指标。
中期功能状态的改善与神经激素反射控制的恢复相关。功能状态受抑制程度较轻（峰值VO₂）是CRT反应者最强的预测指标。
