Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.
Heart Fail Rev. 2011 May;16(3):205-14. doi: 10.1007/s10741-010-9214-2.
Cardiac resynchronization therapy is a key non-pharmacological treatment strategy for drug-refractory moderate-to-severe symptomatic heart failure in the presence of compromised left ventricular function and ventricular conduction delay. Because not all patients with conventional criteria benefit from CRT, continuous efforts have been directed toward improving patient selection; in particular, emerging echocardiographic criteria such as regional and global myocardial strains are being investigated to better predict CRT response. In the meantime, growing evidence from large randomized controlled trials (RCTs, REVERSE, and MADIT-CRT) has demonstrated that even mildly symptomatic patients may benefit from CRT. The role of CRT in heart failure patients with narrow QRS, however, remains to be defined in the scheme of larger RCTs (such as EchoCRT) as the ones carried out thus far (RethinQ and ESTEEM-CRT). Important experimental data derived from animal heart failure models are gradually elucidating the complex pathophysiological basis of cardiac dyssynchrony, which involves diffuse alterations from genome to structure. At the same time, technological breakthroughs, such as wireless endocardial cardiac pacing, will render the prospect of delivering CRT more precisely and more effectively, a reality in the near future.
心脏再同步治疗是一种关键的非药物治疗策略，适用于存在左心室功能受损和心室传导延迟的药物难治性中重度有症状心力衰竭患者。由于并非所有符合传统标准的患者都能从 CRT 中获益，因此一直在不断努力改进患者选择；特别是新兴的超声心动图标准，如区域性和整体心肌应变，正在被研究以更好地预测 CRT 反应。与此同时，来自大型随机对照试验（REVERSE 和 MADIT-CRT）的越来越多的证据表明，即使是轻度有症状的患者也可能从 CRT 中获益。然而，在更大规模的 RCT（如 EchoCRT）中，心脏再同步治疗在 QRS 波群狭窄的心力衰竭患者中的作用仍有待确定，因为迄今为止进行的 RCT（如 RethinQ 和 ESTEEM-CRT）还没有明确这一作用。来自动物心力衰竭模型的重要实验数据逐渐阐明了心脏不同步的复杂病理生理基础，其中涉及从基因组到结构的广泛改变。与此同时，无线心内膜心脏起搏等技术突破将使更精确、更有效地提供 CRT 的前景成为现实。
