Cardiovascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Eur Heart J. 2011 Jan;32(1):93-103. doi: 10.1093/eurheartj/ehq389. Epub 2010 Oct 22.
Ischaemic heart disease negatively impacts response to cardiac resynchronization therapy (CRT), yet the impact of infarct scar burden on clinical outcomes and its interaction with mechanical dyssynchrony have not been well described.
We studied 620 NYHA classes III-IV heart failure patients with ejection fraction (EF) ≤ 35% and QRS duration ≥120 ms referred for CRT. Included were 190 ischaemic cardiomyopathy (ICM) CRT recipients with scar burden quantified by rest-redistribution Tl(201) myocardial perfusion imaging using a 17-segment (0 = normal to 4 = absence of uptake) summed rest score (SRS). Non-ICM (NICM) CRT recipients (n = 380) and 50 patients referred for CRT with unsuccessful LV lead implant comprised the comparison groups. Echocardiographic dyssynchrony analysis was performed in a subgroup of 150 patients. Follow-up left ventricular EF (LVEF) and volumes were examined at 7 ± 3 months in 143 patients. The outcome of death, cardiac transplant, or mechanical circulatory support was assessed in all. Over 2.1 ± 1.6 years, ICM patients had significantly worse survival and less LVEF improvement than NICM patients (P < 0.01). Ischaemic cardiomyopathy patients with low scar burden (SRS < 27) had favourable survival and LVEF improvement, similar to NICM patients. A high scar burden (SRS ≥ 27) was associated with reduced survival and lack of LV functional improvement (P ≤ 0.01), similar to those with unsuccessful LV lead implant, whereas baseline dyssynchrony was not predictive of outcome in these patients.
Extensive scar burden in ICM patients unfavourably affected clinical and LV functional outcomes after CRT, regardless of baseline dyssynchrony measures. Patients with ICM and lower scar burden had significantly better outcomes, similar to NICM patients.
缺血性心脏病对心脏再同步治疗（CRT）的反应产生负面影响，但梗死瘢痕负担对临床结果的影响及其与机械不同步的相互作用尚未得到很好的描述。
我们研究了 620 名 NYHA 分级 III-IV 级、射血分数（EF）≤35%和 QRS 持续时间≥120ms 的心力衰竭患者，这些患者被推荐进行 CRT。其中包括 190 名缺血性心肌病（ICM）CRT 受者，通过使用 17 段（0=正常至 4=无摄取）总和静息评分（SRS）的静息再分布 Tl（201）心肌灌注成像量化瘢痕负担。非缺血性心肌病（NICM）CRT 受者（n=380）和 50 名因 LV 导联植入不成功而接受 CRT 推荐的患者构成了对照组。在 150 名患者的亚组中进行了超声心动图不同步分析。在 143 名患者中，在 7±3 个月时检查了左心室射血分数（LVEF）和容量的随访结果。所有患者均评估了死亡、心脏移植或机械循环支持的结局。在 2.1±1.6 年期间，ICM 患者的生存率和 LVEF 改善明显低于 NICM 患者（P<0.01）。瘢痕负荷低（SRS<27）的缺血性心肌病患者的生存率和 LVEF 改善情况良好，与 NICM 患者相似。高瘢痕负荷（SRS≥27）与生存率降低和 LV 功能改善缺乏相关（P≤0.01），与 LV 导联植入不成功的患者相似，而基线不同步并不能预测这些患者的结局。
在 ICM 患者中，广泛的瘢痕负担对 CRT 后临床和 LV 功能结局产生不利影响，无论基线不同步测量如何。瘢痕负荷较低的 ICM 患者的预后明显改善，与 NICM 患者相似。
