António Natália, Teixeira Rogério, Coelho Lourenço, Lourenço Carolina, Monteiro Pedro, Ventura Miguel, Cristóvão João, Elvas Luís, Gonçalves Lino, Providência Luís A
Department of Cardiology, Coimbra University Hospital and Medical School, Avenida Bissaya Barreto, 3000-076 Coimbra, Portugal.
Europace. 2009 Mar;11(3):343-9. doi: 10.1093/europace/eup038.
Some patients show such an important clinical improvement and reverse remodelling after cardiac resynchronization therapy (CRT) that anatomy and function approach normal. These patients have been called 'super-responders'. The aim of our study was to identify predictors of becoming a super-responder after CRT.
Eighty-seven consecutive patients who underwent CRT were prospectively studied. Before CRT and 6 months after, clinical and echocardiographic evaluation was performed. Patients with a decrease in New York Heart Association functional class >or=1, a two-fold or more increase of left ventricular ejection fraction (LVEF) or a final LVEF >45%, and a decrease in LV end-systolic volume >15% were classified as super-responders. There were 12% super-responders. At baseline, there were no significant differences between super-responders and the other patients, except for the fact that super-responders had significantly smaller mitral regurgitation and LV end-diastolic diameter (LVEDD) and a shorter duration of heart failure symptoms. Mitral regurgitation jet area, LVEDD, and duration of heart failure symptoms were correlated with this super-response. Moreover, an evolution of symptoms for <12 months was an independent predictor of super-response to CRT.
Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.
一些患者在心脏再同步治疗（CRT）后表现出显著的临床改善和逆向重构，使解剖结构和功能接近正常。这些患者被称为“超级反应者”。我们研究的目的是确定CRT后成为超级反应者的预测因素。
对连续87例行CRT的患者进行前瞻性研究。在CRT前和CRT后6个月，进行临床和超声心动图评估。纽约心脏协会功能分级下降≥1级、左心室射血分数（LVEF）增加两倍或更多或最终LVEF>45%，以及左心室收缩末期容积减少>15%的患者被归类为超级反应者。超级反应者占12%。在基线时，超级反应者与其他患者之间没有显著差异，只是超级反应者的二尖瓣反流和左心室舒张末期直径（LVEDD）明显较小，且心力衰竭症状持续时间较短。二尖瓣反流喷射面积、LVEDD和心力衰竭症状持续时间与这种超级反应相关。此外，症状演变<12个月是CRT超级反应的独立预测因素。
心肌病处于早期阶段、心室几何形状改变较小的患者似乎更有可能成为超级反应者。
