Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Villarroel 136, 08036 Barcelona, Spain.
Eur J Heart Fail. 2010 Mar;12(3):283-7. doi: 10.1093/eurjhf/hfq003.
We hypothesized that a very advanced stage of dilated cardiomyopathy is associated with lower response to cardiac resynchronization therapy (CRT).
A consecutive cohort of 147 patients was studied before device implantation and at 12 months follow-up. All patients were in NYHA functional class III-IV and had left-ventricular (LV) systolic dysfunction (LV ejection fraction 24 +/- 7%) and a wide QRS (171 +/- 29 ms). A patient who was alive without heart transplantation and had improved by at least 10% in the 6 min walking test at 12 months follow-up was considered a clinical responder. Fifty-four patients (36%) did not respond to CRT (15 cardiac deaths, 4 heart transplantations). Quality of life indicators (>41 points), LV end-diastolic volumes (>200 mL) and mitral regurgitant orifice area (>16 mm(2)) at baseline were independent predictors of response to CRT. Patients were assigned 1 point for each predictive parameter. Patients with higher scores showed a significantly higher likelihood of non-response to CRT (chi(2) = 12 891, P = 0.005).
The results show that non-responder patients have a more advanced stage of the disease, which suggests that CRT should be indicated earlier in the disease process.
我们假设扩张型心肌病的晚期与心脏再同步治疗（CRT）的反应较低有关。
研究了 147 例连续患者，在植入设备前和 12 个月随访时进行了研究。所有患者均处于 NYHA 功能 III-IV 级，左心室（LV）收缩功能障碍（LV 射血分数 24 +/- 7%）和宽 QRS（171 +/- 29 ms）。在 12 个月随访时，至少提高了 10%的 6 分钟步行试验的患者被认为是临床反应者。54 例患者（36%）对 CRT 无反应（15 例心脏死亡，4 例心脏移植）。基线时生活质量指标（>41 分）、LV 舒张末期容积（>200 mL）和二尖瓣反流口面积（>16 mm(2))）是 CRT 反应的独立预测因子。患者每个预测参数得 1 分。得分较高的患者对 CRT 的反应明显较低（卡方=12891，P=0.005）。
结果表明，无反应患者的疾病处于更晚期，这表明 CRT 应在疾病过程的早期进行。
