Buck Sandra, Maass Alexander H, Nieuwland Wybe, Anthonio Rutger L, Van Veldhuisen Dirk J, Van Gelder Isabelle C
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands.
Europace. 2008 Nov;10(11):1313-9. doi: 10.1093/europace/eun208. Epub 2008 Aug 11.
To investigate the influence of interlead distance and lead positioning on success of cardiac resynchronization therapy (CRT) in patients with advanced chronic heart failure and electrical dyssynchrony. Despite application of established selection criteria, 20-40% of the patients do not respond to CRT.
We examined consecutive patients in whom CRT was implanted. Response to CRT was defined as a decrease in the left ventricular end-systolic volume >or=10% after 6 months. A comparison was made between patients who were responders to CRT and those who were non-responders. A univariate and stepwise multivariate logistic regression was performed with regard to predictors for response. Between January 2004 and January 2008, 174 patients who were treated with CRT were classified as responders [n = 95 (55%)] or non-responders [n = 79 (45%)]. Responders had a significantly larger horizontal interlead distance on the lateral thoracic X-ray [odds ratio (OR) 2.8 (1.2-6.6), P = 0.01], a septal-to-lateral delay >60 ms [OR 4.9 (2.0-11.4), P < 0.0001], non-ischaemic cardiomyopathy [OR 3.0 (1.3-6.9), P = 0.009], a left ventricular end-diastolic diameter <67 mm [OR 4.2 (1.8-9.9), P = 0.001], angiotensin-converting enzyme inhibitor use [OR 8.1 (1.7-38.2), P = 0.008], and no tricuspid valve insufficiency [OR 6.9 (1.3-35.5), P = 0.02]. Post-implantation responders had a significantly greater decrease in the intraventricular delay (septal-to-lateral delay 62 +/- 62 vs. 26 +/- 65 ms, P = 0.001), but not in the interventricular mechanical delay.
Larger interlead distance on the lateral thoracic X-ray, associated with positioning of the left ventricular lead in the posterior position, is associated with response after 6 months of follow-up. Furthermore, diminishing the septal-to-lateral delay is predictive for response.
探讨电极间距和电极位置对晚期慢性心力衰竭伴电不同步患者心脏再同步治疗（CRT）成功率的影响。尽管应用了既定的选择标准，但仍有20% - 40%的患者对CRT无反应。
我们对连续接受CRT植入的患者进行了检查。CRT反应定义为6个月后左心室收缩末期容积减少≥10%。对CRT反应者和无反应者进行了比较。对反应的预测因素进行了单因素和逐步多因素逻辑回归分析。在2004年1月至2008年1月期间，174例接受CRT治疗的患者被分类为反应者[n = 95（55%）]或无反应者[n = 79（45%）]。反应者在胸部侧位X线片上的水平电极间距明显更大[比值比（OR）2.8（1.2 - 6.6），P = 0.01]，室间隔至侧壁延迟>60毫秒[OR 4.9（2.0 - 11.4），P < 0.0001]，非缺血性心肌病[OR 3.0（1.3 - 6.9），P = 0.009]，左心室舒张末期直径<67毫米[OR 4.2（1.8 - 9.9），P = 0.001]，使用血管紧张素转换酶抑制剂[OR 8.1（1.7 - 38.2），P = 0.008]，且无二尖瓣关闭不全[OR 6.9（1.3 - 35.5），P = 0.02]。植入后反应者的室内延迟明显更大程度地降低（室间隔至侧壁延迟62±62 vs. 26±65毫秒，P = 0.001），但心室间机械延迟无明显降低。
胸部侧位X线片上较大的电极间距，与左心室电极置于后侧位置相关，与随访6个月后的反应相关。此外，减少室间隔至侧壁延迟可预测反应。
