García-Seara Javier, Martínez-Sande José L, Cid Belén, Gude Francisco, Bastos María, Domínguez Miguel, Varela Alfonso, González-Juanatey José R
Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain.
Rev Esp Cardiol. 2008 Dec;61(12):1245-52. doi: 10.1016/s1885-5857(09)60051-7.
The aim of this study was to determine whether measurement of the QRS axis can help to predict outcome in patients undergoing cardiac resynchronization therapy.
The study included 78 patients who had undergone successful cardiac resynchronization device implantation. Patients were classified as having either a normal QRS axis (i.e., between -30 degrees and +120 degrees) or a left QRS axis deviation (i.e., between -30 degrees and -90 degrees). Patients were regarded as responders if they fulfilled all of the following criteria: their functional class improved by at least one grade, their left ventricular ejection fraction increased by at least 5%, they did not need hospitalization for worsening heart failure, and they were still alive at 12-month follow-up.
After adjustment for age, preimplantation left ventricular ejection fraction, etiology and mitral regurgitation, a statistically significant interaction was found between the QRS axis and lead location (P=.026). There was a better response with an anterior lead location if the patient had a left QRS axis deviation.
A significant interaction was found between the lead location and the preimplantation QRS electrical axis, such that there was a better response to resynchronization therapy when the lead was implanted in the anterior interventricular vein if the patient had a left QRS axis deviation.
本研究旨在确定QRS轴测量是否有助于预测接受心脏再同步治疗患者的预后。
该研究纳入了78例成功植入心脏再同步装置的患者。患者被分为QRS轴正常（即-30度至+120度之间）或QRS轴左偏（即-30度至-90度之间）两类。若患者满足以下所有标准，则被视为有反应者：功能分级至少改善一级、左心室射血分数至少增加5%、无需因心力衰竭恶化住院且在12个月随访时仍存活。
在对年龄、植入前左心室射血分数、病因和二尖瓣反流进行校正后，发现QRS轴与导线位置之间存在统计学显著的相互作用（P = 0.026）。如果患者存在QRS轴左偏，在前侧导线位置时反应更好。
发现导线位置与植入前QRS电轴之间存在显著的相互作用，即如果患者存在QRS轴左偏，将导线植入前室间静脉时对再同步治疗的反应更好。
