Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Am Heart J. 2010 Oct;160(4):737-43. doi: 10.1016/j.ahj.2010.07.016.
Although most patients who improve in clinical status after cardiac resynchronization therapy (CRT) also show a significant left ventricular (LV) reverse remodeling, some patients do not show echocardiographic improvement. The aim of the present study was to evaluate the degree of agreement between clinical and echocardiographic response to CRT in a large cohort of heart failure patients, and to evaluate the characteristics of patients with clinical response but without echocardiographic response.
In 440 consecutive heart failure patients (mean age 66 ± 11 years, 81% men) treated with CRT, agreement between clinical and echocardiographic responses at 6 months of follow-up were evaluated. The combined clinical response was defined as: ≥1-point New York Heart Association functional class improvement or ≥15% increase in 6-minute walk test. Echocardiographic response was defined by a reduction in LV end-systolic volume (LVESV) ≥15%.
At 6 months of follow-up, clinical response was observed in 84% (n = 370) of the patients. Significant reduction in LVESV was noted in 63% (n = 276). The majority of patients who improved clinically did show LV reverse remodeling (72%, n = 268). Importantly, 28% (n = 102) of patients who improved clinically did not show significant LV reverse remodeling. The patients with clinical response but without echocardiographic response had more often ischemic heart failure as compared to patients with positive clinical and echocardiographic response (69.6% vs 57.5%; P = .021). Moreover, patients with such discordant responses had more narrow QRS complex (148 ± 31 vs 159 ± 31 milliseconds; P = .004), and showed less LV dyssynchrony than patients with concordant positive responses (90 ± 77 vs 171 ± 105 milliseconds; P < .001).
Although there is a good concordance between echocardiographic and clinical response to CRT, up to 28% of the population experienced clinical response without significant LV reverse remodeling. Subjects with such discrepant responses have more frequently ischemic heart failure and show more narrow QRS complex and less LV dyssynchrony than patients with both clinical and echocardiographic response.
虽然大多数在心脏再同步治疗（CRT）后临床状况改善的患者也表现出显著的左心室（LV）逆重构，但有些患者没有表现出超声心动图的改善。本研究的目的是评估在一大群心力衰竭患者中，临床和超声心动图对 CRT 反应的一致性程度，并评估临床反应但无超声心动图反应的患者的特征。
在 440 例连续接受 CRT 治疗的心力衰竭患者（平均年龄 66±11 岁，81%为男性）中，评估了 6 个月随访时临床和超声心动图反应的一致性。联合临床反应定义为：纽约心脏协会功能分级改善≥1 级或 6 分钟步行试验增加≥15%。超声心动图反应定义为左室收缩末期容积（LVESV）减少≥15%。
在 6 个月的随访中，84%（n=370）的患者出现临床反应。LVESV 显著减少见于 63%（n=276）的患者。大多数临床改善的患者确实表现出 LV 逆重构（72%，n=268）。重要的是，28%（n=102）临床改善但没有显著 LV 逆重构的患者。与临床和超声心动图反应均为阳性的患者相比，临床反应但无超声心动图反应的患者更常患有缺血性心力衰竭（69.6%比 57.5%；P=0.021）。此外，这些不一致反应的患者 QRS 波群更窄（148±31 比 159±31 毫秒；P=0.004），与具有一致阳性反应的患者相比，LV 不同步程度更小（90±77 比 171±105 毫秒；P<0.001）。
尽管 CRT 的超声心动图和临床反应之间存在良好的一致性，但多达 28%的人群出现临床反应而没有显著的 LV 逆重构。与具有临床和超声心动图反应的患者相比，具有这种不一致反应的患者更常患有缺血性心力衰竭，且 QRS 波群更窄，LV 不同步程度更小。
