Department of Cardiology, Leiden University Medical Center, The Netherlands.
Am Heart J. 2011 Mar;161(3):552-7. doi: 10.1016/j.ahj.2010.11.011. Epub 2011 Jan 31.
Lack of response to cardiac resynchronization therapy (CRT) ranges between 30% to 40% of heart failure (HF) patients. The present study aimed to evaluate the clinical and echocardiographic determinants of nonresponse to CRT.
A total of 581 patients (66.4 ± 10.0 years, 77.9% male) with advanced HF scheduled for CRT implantation were included. Clinical and echocardiographic evaluations were performed at baseline and 6 months of follow-up. Nonresponse was defined as no improvement in the New York Heart Association functional class, death from worsening HF or heart transplantation, and <15% reduction in left ventricular (LV) end-systolic volume.
At 6 months of follow-up, 254 patients (44%) did not respond to CRT. The nonresponders were more frequently male (81.9% vs 74.3%, P = .030) and had ischemic cardiomyopathy (69.7% vs 53.2%, P < .001), shorter QRS duration (150.6 ± 29.9 milliseconds vs 156.0 ± 32.5 milliseconds, P = .041), worse New York Heart Association functional class (2.8 ± 0.6 vs 2.7 ± 0.6, P = .008) and shorter 6-minute walk distance (297.9 ± 110.7 m vs 331.8 ± 112.6 m, P = .001), larger left atrial volumes (44.9 ± 16.9 mL/m(2) vs 40.9 ± 17.6 mL/m(2), P = .006), less baseline LV dyssynchrony (56.2 ± 41.3 milliseconds vs 69.1 ± 39.9 milliseconds, P < .001), and, more frequently, anterior LV lead position (12.4% vs 4.0%, P = .007). At multivariate analysis, only the ischemic etiology of HF (odds ratio [OR] 2.264, P = .005), shorter 6-minute walk distance at baseline (OR 0.998, P = .030), less baseline LV dyssynchrony (OR 0.989, P < .001), and anterior LV lead position (OR 3.713, P < .010) remained independent predictors of nonresponse to CRT.
Ischemic etiology of HF, shorter baseline 6-minute walk distance, less baseline LV dyssynchrony, and anterior LV lead position are independent determinants of nonresponse to CRT.
心脏再同步治疗（CRT）的无反应率在 30%至 40%的心力衰竭（HF）患者之间变化。本研究旨在评估 CRT 无反应的临床和超声心动图决定因素。
共纳入 581 例（66.4±10.0 岁，77.9%为男性）拟行 CRT 植入的晚期 HF 患者。基线和 6 个月随访时进行临床和超声心动图评估。无反应定义为纽约心脏协会（NYHA）功能分级无改善、因 HF 恶化或心脏移植而死亡、左心室（LV）收缩末期容积减少<15%。
随访 6 个月时，254 例（44%）患者对 CRT 无反应。无反应者更常为男性（81.9%比 74.3%，P=0.030），且为缺血性心肌病（69.7%比 53.2%，P<0.001）、QRS 时限更短（150.6±29.9 毫秒比 156.0±32.5 毫秒，P=0.041）、NYHA 功能分级更差（2.8±0.6 比 2.7±0.6，P=0.008）、6 分钟步行距离更短（297.9±110.7 m 比 331.8±112.6 m，P=0.001）、左心房容积更大（44.9±16.9 mL/m2 比 40.9±17.6 mL/m2，P=0.006）、LV 不同步程度更低（56.2±41.3 毫秒比 69.1±39.9 毫秒，P<0.001），且更常为前 LV 导联位置（12.4%比 4.0%，P=0.007）。多变量分析显示，HF 的缺血性病因（比值比[OR]2.264，P=0.005）、基线 6 分钟步行距离更短（OR 0.998，P=0.030）、LV 不同步程度更低（OR 0.989，P<0.001）和前 LV 导联位置（OR 3.713，P<0.010）是 CRT 无反应的独立预测因素。
HF 的缺血性病因、基线 6 分钟步行距离较短、LV 不同步程度较低和前 LV 导联位置是 CRT 无反应的独立决定因素。
