Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Eur Heart J. 2009 Oct;30(20):2470-7. doi: 10.1093/eurheartj/ehp368. Epub 2009 Aug 30.
Predictors of Response to Cardiac Resynchronization Therapy (CRT) (PROSPECT) was the first large-scale, multicentre clinical trial that evaluated the ability of several echocardiographic measures of mechanical dyssynchrony to predict response to CRT. Since response to CRT may be defined as a spectrum and likely influenced by many factors, this sub-analysis aimed to investigate the relationship between baseline characteristics and measures of response to CRT.
A total of 286 patients were grouped according to relative reduction in left ventricular end-systolic volume (LVESV) after 6 months of CRT: super-responders (reduction in LVESV > or =30%), responders (reduction in LVESV 15-29%), non-responders (reduction in LVESV 0-14%), and negative responders (increase in LVESV). In addition, three subgroups were formed according to clinical and/or echocardiographic response: +/+ responders (clinical improvement and a reduction in LVESV > or =15%), +/- responders (clinical improvement or a reduction in LVESV > or =15%), and -/- responders (no clinical improvement and no reduction in LVESV > or =15%). Differences in clinical and echocardiographic baseline characteristics between these subgroups were analysed. Super-responders were more frequently females, had non-ischaemic heart failure (HF), and had a wider QRS complex and more extensive mechanical dyssynchrony at baseline. Conversely, negative responders were more frequently in New York Heart Association class IV and had a history of ventricular tachycardia (VT). Combined positive responders after CRT (+/+ responders) had more non-ischaemic aetiology, more extensive mechanical dyssynchrony at baseline, and no history of VT.
Sub-analysis of data from PROSPECT showed that gender, aetiology of HF, QRS duration, severity of HF, a history of VT, and the presence of baseline mechanical dyssynchrony influence clinical and/or LV reverse remodelling after CRT. Although integration of information about these characteristics would improve patient selection and counselling for CRT, further randomized controlled trials are necessary prior to changing the current guidelines regarding patient selection for CRT.
心脏再同步治疗（CRT）反应预测（PROSPECT）是首个评估几种机械不同步超声心动图测量值预测 CRT 反应能力的大型多中心临床试验。由于 CRT 反应可能定义为一个谱，并且可能受到许多因素的影响，因此本亚分析旨在研究基线特征与 CRT 反应之间的关系。
根据 CRT 后 6 个月左心室收缩末期容积（LVESV）的相对减少，将 286 例患者分为以下几组：超反应者（LVESV 减少≥30%）、反应者（LVESV 减少 15-29%）、无反应者（LVESV 减少 0-14%）和负反应者（LVESV 增加）。此外，根据临床和/或超声心动图反应，将患者分为以下三个亚组：+/+反应者（临床改善和 LVESV 减少≥15%）、+/–反应者（临床改善或 LVESV 减少≥15%）和-/-反应者（无临床改善和 LVESV 减少<15%）。分析这些亚组之间的临床和超声心动图基线特征差异。超反应者女性居多，为非缺血性心力衰竭（HF），基线时 QRS 波群更宽，机械不同步程度更严重。相反，负反应者更常见纽约心脏协会（NYHA）心功能分级 IV 级，且有室性心动过速（VT）病史。CRT 后综合阳性反应者（+/+反应者）的非缺血性病因更多，基线时机械不同步程度更严重，且无 VT 病史。
PROSPECT 数据的亚分析表明，性别、HF 的病因、QRS 持续时间、HF 的严重程度、VT 病史和基线机械不同步性影响 CRT 后的临床和/或 LV 逆重构。尽管整合这些特征的信息可以改善 CRT 患者的选择和咨询，但在改变 CRT 患者选择的现行指南之前，还需要进行更多的随机对照试验。
