心脏再同步治疗无应答和超应答的潜在预测因素。

Potential predictors of non-response and super-response to cardiac resynchronization therapy.

机构信息

Centre of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2011 May;124(9):1338-441.

PMID:21740744

Abstract

BACKGROUND

Although cardiac resynchronization therapy (CRT) is already an established treatment, the characteristics of patients who have an excellent response to CRT and those who get no benefit remain to be determined. The purpose of this study was to search for potential predictors of both non-response and super-response to CRT.

METHODS

Seventy-six consecutive patients who received CRT treatment were divided into group A (non-responders), group C (super-responders) and group B (responders exclusive of super-responders). Student's t test, Mann-Whitney test, Logistic regression and receiver operating characteristic curve were employed to identify potential predictors among the patients' demographic characteristics, clinical features, several electrocardiographic parameters before and after CRT implantation, and their pre-implant echocardiographic parameters.

RESULTS

Group A had the lowest 3-month left ventricular ejection fraction (LVEF). Group C had the smallest pre-implant left ventricular end-diastolic dimension (LVEDD), the shortest post-implant QRS duration, the smallest 3-month LVEDD and the highest 3-month LVEF. In addition, there was a trend of gradual change in percent of left bundle branch block, severity of pre-implant mitral regurgitation, pre-implant QRS dispersion, post-implant QRS duration as well as post-implant QRS dispersion from group A to group B and from group B to group C. Multivariable Logistic analysis revealed that only pre-implant LVEDD could predict CRT super-response. A pre-implant LVEDD of 68.5 mm was the cut-off value that identified super-responders with 87.5% sensitivity and 79.7% specificity. A pre-implant LVEDD of 62.5 mm identified super-responders with 50.0% sensitivity and 89.8% specificity.

CONCLUSIONS

Predictors of a CRT non-response remain unclear at present. But it is credible that patients with a smaller left ventricle would have a better chance to become super-responders to CRT.

摘要

背景

尽管心脏再同步治疗（CRT）已经是一种既定的治疗方法，但对 CRT 反应良好和无获益的患者的特征仍有待确定。本研究的目的是寻找对 CRT 无反应和超反应的潜在预测因素。

方法

76 例连续接受 CRT 治疗的患者分为 A 组（无反应者）、C 组（超反应者）和 B 组（除超反应者外的反应者）。采用 Student's t 检验、Mann-Whitney 检验、Logistic 回归和受试者工作特征曲线来识别患者的人口统计学特征、临床特征、CRT 植入前后的几个心电图参数以及其植入前超声心动图参数中的潜在预测因素。

结果

A 组的 3 个月左心室射血分数（LVEF）最低。C 组的左心室舒张末期内径（LVEDD）最小，CRT 植入后的 QRS 持续时间最短，3 个月 LVEDD 最小，3 个月 LVEF 最高。此外，从 A 组到 B 组，以及从 B 组到 C 组，左束支传导阻滞的百分比、植入前二尖瓣反流的严重程度、植入前 QRS 离散度、植入后 QRS 持续时间和植入后 QRS 离散度均呈逐渐变化的趋势。多变量 Logistic 分析显示，只有植入前 LVEDD 才能预测 CRT 超反应。植入前 LVEDD 为 68.5mm 时，识别超反应者的敏感性为 87.5%，特异性为 79.7%。植入前 LVEDD 为 62.5mm 时，识别超反应者的敏感性为 50.0%，特异性为 89.8%。