Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Circulation. 2011 Jan 4;123(1):70-8. doi: 10.1161/CIRCULATIONAHA.110.945345. Epub 2010 Dec 20.
The relative merits of left ventricular (LV) dyssynchrony, LV lead position, and myocardial scar to predict long-term outcome after cardiac resynchronization therapy remain unknown and were evaluated in the present study.
In 397 ischemic heart failure patients, 2-dimensional speckle tracking imaging was performed, with comprehensive assessment of LV radial dyssynchrony, identification of the segment with latest mechanical activation, and detection of myocardial scar in the segment where the LV lead was positioned. For LV dyssynchrony, a cutoff value of 130 milliseconds was used. Segments with <16.5% radial strain in the region of the LV pacing lead were considered to have extensive myocardial scar (>50% transmurality, validated in a subgroup with contrast-enhanced magnetic resonance imaging). The LV lead position was derived from chest x-ray. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Mean baseline LV radial dyssynchrony was 133±98 milliseconds. In 271 patients (68%), the LV lead was placed at the latest activated segment (concordant LV lead position), and the mean value of peak radial strain at the targeted segment was 18.9±12.6%. Larger LV radial dyssynchrony at baseline was an independent predictor of superior long-term survival (hazard ratio, 0.995; P=0.001), whereas a discordant LV lead position (hazard ratio, 2.086; P=0.001) and myocardial scar in the segment targeted by the LV lead (hazard ratio, 2.913; P<0.001) were independent predictors of worse outcome. Addition of these 3 parameters yielded incremental prognostic value over the combination of clinical parameters.
Baseline LV radial dyssynchrony, discordant LV lead position, and myocardial scar in the region of the LV pacing lead were independent determinants of long-term prognosis in ischemic heart failure patients treated with cardiac resynchronization therapy. Larger baseline LV dyssynchrony predicted superior long-term survival, whereas discordant LV lead position and myocardial scar predicted worse outcome.
左心室（LV）不同步、LV 导联位置和心肌瘢痕预测心脏再同步治疗后长期预后的相对优势尚不清楚，本研究对此进行了评估。
在 397 例缺血性心力衰竭患者中，进行了 2 维斑点追踪成像，全面评估 LV 径向不同步，确定机械激活最晚的节段，并检测 LV 导联所在节段的心肌瘢痕。对于 LV 不同步，使用 130 毫秒的截止值。在 LV 起搏导联区域内径向应变<16.5%的节段被认为存在广泛的心肌瘢痕（>50%透壁性，在亚组中通过对比增强磁共振成像验证）。LV 导联位置源自胸部 X 射线。长期随访包括全因死亡率和心力衰竭住院率。平均基线 LV 径向不同步为 133±98 毫秒。在 271 例患者（68%）中，LV 导联放置在最晚激活的节段（一致的 LV 导联位置），靶向节段的峰值径向应变平均值为 18.9±12.6%。基线时较大的 LV 径向不同步是长期生存的独立预测因素（危险比，0.995；P=0.001），而不一致的 LV 导联位置（危险比，2.086；P=0.001）和 LV 起搏导联靶向节段的心肌瘢痕（危险比，2.913；P<0.001）是预后较差的独立预测因素。这 3 个参数的加入比临床参数的组合提供了额外的预后价值。
缺血性心力衰竭患者接受心脏再同步治疗后，基线 LV 径向不同步、不一致的 LV 导联位置和 LV 起搏导联区域的心肌瘢痕是长期预后的独立决定因素。较大的基线 LV 不同步预测长期生存较好，而不一致的 LV 导联位置和心肌瘢痕则预测预后较差。
