Castellant Philippe, Orhan Erwann, Bertault-Valls Valerie, Fatemi Marjaneh, Etienne Yves, Blanc Jean-Jacques
Department of Cardiology, Hôpital de la Cavale Blanche, Brest University Hospital, Boulevard Tanguy Prigent, Brest Cedex, France.
Ann Noninvasive Electrocardiol. 2010 Oct;15(4):321-7. doi: 10.1111/j.1542-474X.2010.00387.x.
Some patients treated by cardiac resynchronization therapy (CRT) recover "normal" left ventricular (LV) function and functional status. However, whether this "normalization" persists or reverts over time remains unknown. The aim of the present study was to evaluate the long-term outcomes of LV function in patients hyper responder to CRT.
Eleven consecutive patients with nonischemic dilated cardiomyopathy, sinus rhythm, left bundle branch block (LBBB), New York Heart Association (NYHA) class III or IV, and optimal pharmacological treatment were hyper responder as they fulfilled concurrently the two following criteria: functional recovery (NYHA class I or II) and normalization of LV ejection fraction (LVEF).
After a mean follow-up of 65 ± 30 months between CRT implantation and last evaluation LVEF improved from 26 ± 9 to 59 ± 6% (P < 0.0001). One patient died from pulmonary embolism 31 months after implantation. Three patients exhibited LVEF ≤ 50% at their last follow-up visit (two at 40% and one at 45%). In eight patients, brief cessation of pacing was feasible (three were pacemaker-dependent). Mean QRS duration decreased from 181 ± 23 ms to 143 ± 22 ms (P = 0.006). In one patient, pacing was interrupted for 2 years and LVEF decreased markedly (from 65% to 31%) but returned to normal after a few months when pacing was resumed.
In hyper responder patients, "normalization" of LV function after CRT persists as long as pacing is maintained with an excellent survival.
一些接受心脏再同步治疗（CRT）的患者恢复了“正常”的左心室（LV）功能和功能状态。然而，这种“正常化”是否会随着时间持续存在或逆转仍不清楚。本研究的目的是评估CRT超反应者左心室功能的长期预后。
连续入选11例非缺血性扩张型心肌病、窦性心律、左束支传导阻滞（LBBB）、纽约心脏协会（NYHA）心功能III或IV级且接受最佳药物治疗的患者，这些患者同时满足以下两个标准，即为超反应者：功能恢复（NYHA心功能I或II级）和左心室射血分数（LVEF）正常化。
在CRT植入至最后一次评估期间，平均随访65±30个月，LVEF从26±9%提高到59±6%（P<0.0001）。1例患者在植入后31个月死于肺栓塞。3例患者在最后一次随访时LVEF≤50%（2例为40%，1例为45%）。8例患者可行短暂起搏停止（3例依赖起搏器）。平均QRS时限从181±23ms降至143±22ms（P=0.006）。1例患者起搏中断2年，LVEF显著下降（从65%降至31%），但在恢复起搏几个月后恢复正常。
在CRT超反应者中，只要维持起搏且生存率良好，CRT后左心室功能的“正常化”就会持续存在。
