Department of Cardiology, University of Bologna, Bologna, Italy.
Heart. 2011 Feb;97(4):295-300. doi: 10.1136/hrt.2010.211607. Epub 2010 Dec 16.
To compare the effects of cardiac resynchronisation therapy (CRT) on left ventricular (LV) reverse remodelling in patients with dilated cardiomyopathy (DCM) associated or not with isolated ventricular non-compaction (IVNC).
52 patients with heart failure, candidates for CRT, were recruited: 20 patients with IVNC associated with DCM (IVNC-DCM) without other coexisting cardiac diseases and 32 patients with DCM without IVNC matched for age, gender, body surface area and LV systolic function. Standard and contrast echocardiography were used to assess LV volumes and function and to optimise visualisation of the endocardial border at baseline and at 6 months' follow-up. Patients with heart failure were subsequently classified as CRT negative responders, non-responders, responders or super-responders based on different LV reverse remodelling 6 months after CRT implantation. Different types of CRT response were observed in IVNC-DCM and DCM patients. In particular, in IVNC-DCM patients the percentage of super-responders was significantly higher than for patients with DCM (60% vs 28%, respectively, p = 0.023). In addition, the number of IVNC segments had a trend towards reduction with respect to baseline (4 (3-6)) at 6 months' follow-up (3 (1-5); p = 0.067). Finally, in IVNC-DCM, the patients with a higher number of IVNC segments at baseline (>4) were more likely to be responders or super-responders than patients with ≤ 4 IVNC segments (p = 0.003).
Patients with IVNC-DCM had greater LV reverse remodelling after CRT than patients with DCM. The greater the area of non-compaction (higher number of IVNC segments) the greater the chance of achieving CRT response and greater LV reverse remodelling.
比较心脏再同步治疗（CRT）对扩张型心肌病（DCM）合并或不合并孤立性室壁非致密化（IVNC）患者左心室（LV）逆重构的影响。
共招募了 52 名心力衰竭且适合 CRT 的患者：20 名合并 DCM 的 IVNC 患者（IVNC-DCM），无其他共存心脏疾病，32 名无 IVNC 的 DCM 患者，匹配年龄、性别、体表面积和 LV 收缩功能。标准和对比超声心动图用于评估 LV 容积和功能，并在基线和 6 个月随访时优化心内膜边界的可视化。根据 CRT 植入后 6 个月不同的 LV 逆重构，将心力衰竭患者随后分类为 CRT 阴性反应者、非反应者、反应者或超反应者。在 IVNC-DCM 和 DCM 患者中观察到不同类型的 CRT 反应。特别是，在 IVNC-DCM 患者中，超反应者的比例明显高于 DCM 患者（分别为 60%和 28%，p = 0.023）。此外，与基线相比，IVNC 节段数量在 6 个月随访时有减少趋势（4（3-6））（3（1-5）；p = 0.067）。最后，在 IVNC-DCM 中，基线时 IVNC 节段较多（>4）的患者比 IVNC 节段较少（≤4）的患者更有可能成为反应者或超反应者（p = 0.003）。
与 DCM 患者相比，IVNC-DCM 患者 CRT 后 LV 逆重构更大。非致密化面积越大（IVNC 节段越多），获得 CRT 反应和更大的 LV 逆重构的机会就越大。
