1st Department of Cardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland.
Cardiol J. 2011;18(2):157-64.
The aim of the study was to assess clinical and classic echocardiographic data in patients with different cardiac resynchronization therapy (CRT) outcomes.
Sixty consecutive patients (aged 66.3 ± 8.7 years, 57 men) with chronic heart failure (CHF) in New York Heart Association (NYHA) classes III-IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDD) > 55 mm, left ventricular ejection fraction £ 35% and wide QRS complex (≥ 120 ms), including individuals with permanent atrial fibrillation (AF) and single- and dual-chamber pacing, were assessed firstly before, and secondly three months after, biventricular heart stimulator implantation (excluding three patients who died during the follow-up). Patients developing ≥ 10% reduction of left ventricular end-systolic volume (LVESV) were classified as responders to CRT.
The group of responders (n = 34, 59.7%) and the group of non-responders (n = 23, 40.3%) did not differ regarding baseline echocardiographic parameters or in terms of clinical data of age, gender, concomitant diseases, smoking or pharmacological treatment. The differences involved higher rates of ischemic CHF background, prevalence of hypertension and permanent AF, and a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) among the non-responders. In the multivariate logistic regression analysis, NT-proBNP, body mass index (BMI) and the presence of permanent AF correlated negatively with the magnitude of LVESV reduction following CRT introduction.
Classic echocardiographic data did not predict left ventricle reverse remodeling. Higher rates of ischemic CHF aetiology, hypertension, permanent AF and higher NT-proBNP concentration were found in the group without at least 10% LVESV reduction at the three month follow-up. NT-proBNP, BMI and the presence of permanent AF had negative effects on the magnitude of LVESV.
本研究旨在评估不同心脏再同步治疗（CRT）结局患者的临床和经典超声心动图数据。
连续 60 例（年龄 66.3 ± 8.7 岁，57 名男性）慢性心力衰竭（CHF）患者（纽约心脏协会[NYHA]心功能分级 III-IV 级，尽管接受了优化的药物治疗，但左心室舒张末期直径[LVEDD]＞55mm，左心室射血分数≤35%，宽 QRS 波群（≥120ms），包括永久性心房颤动[AF]和单腔及双腔起搏患者，在双心室心脏刺激器植入前（不包括在随访期间死亡的 3 名患者）首先进行评估，然后在植入后 3 个月再次进行评估。左心室收缩末期容积（LVESV）减少≥10%的患者被归类为 CRT 反应者。
反应者组（n = 34，59.7%）和无反应者组（n = 23，40.3%）在基线超声心动图参数或年龄、性别、合并症、吸烟或药物治疗等临床数据方面无差异。无反应者中，缺血性 CHF 发生率较高、高血压和永久性 AF 更为常见，N 末端脑钠肽前体（NT-proBNP）浓度较高。多变量逻辑回归分析显示，NT-proBNP、体重指数（BMI）和永久性 AF 的存在与 CRT 引入后 LVESV 减少幅度呈负相关。
经典超声心动图数据不能预测左心室逆重构。在 3 个月随访时，LVESV 减少幅度＜10%的患者中，缺血性 CHF 病因、高血压、永久性 AF 和较高的 NT-proBNP 浓度的发生率更高。NT-proBNP、BMI 和永久性 AF 的存在对 LVESV 幅度有负面影响。
