Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Circ Arrhythm Electrophysiol. 2011 Dec;4(6):851-7. doi: 10.1161/CIRCEP.111.962605. Epub 2011 Sep 28.
For patients with symptomatic New York Heart Association class III or IV, ejection fraction ≤ 35%, and QRS ≥ 130 ms, cardiac resynchronization therapy (CRT) has become an established treatment option. However, use of these implant criteria fails to result in clinical or echocardiographic improvement in 30% to 45% of CRT patients.
The Predictors of Response to CRT (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. ECGs collected before, during, and after CRT implantation were analyzed. Primary outcomes were improvement in clinical composite score (CCS) and reduction of left ventricular end systolic volume (LVESV) of >15% after 6 months. Age, sex, cause of cardiomyopathy, myocardial infarction location, right ventricular function, mitral regurgitation, preimplantation QRS width, preimplantation PR interval, preimplantation right ventricular-paced QRS width, preimplantation axis categories, LV-paced QRS width, postimplantation axis categories, difference between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle branch morphological features were analyzed univariably in logistic regression models to predict outcomes. All significant predictors (α=0.1), age, and sex were used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses were also performed. In multivariable analyses, only QRS left bundle branch morphological features predicted both CCS (odds ratio [OR]=2.46, P=0.02) and LVESV (OR=2.89, P=0.048) response. The difference between Bi-V and preimplantation QRS width predicted CCS improvement (OR=0.89, P=0.04). LV-paced QRS width predicted LVESV reduction (OR=0.86, P=0.01). Specifically, an LV-paced QRS width of ≤ 200 ms was predictive of nonischemic LVESV reduction (OR=5.12, P=0.01).
Baseline left bundle branch QRS morphological features, LV-paced QRS width, and the difference between Bi-V and preimplantation QRS width can predict positive outcomes after CRT and may represent a novel intraprocedural method to optimize coronary sinus lead placement.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00253357.
对于有症状的纽约心脏协会（NYHA）III 或 IV 级、射血分数≤35%且 QRS 宽度≥130ms 的患者，心脏再同步治疗（CRT）已成为一种既定的治疗选择。然而，这些植入标准的应用并不能使 30%至 45%的 CRT 患者在临床或超声心动图上得到改善。
预测 CRT 反应的因素（PROSPECT）-ECG 是前瞻性观察性 PROSPECT 试验的一个子研究。在 CRT 植入前后收集心电图并进行分析。主要结局是 6 个月后临床综合评分（CCS）的改善和左心室收缩末期容积（LVESV）减少>15%。在逻辑回归模型中，对年龄、性别、心肌病病因、心肌梗死部位、右心室功能、二尖瓣反流、植入前 QRS 宽度、植入前 PR 间隔、植入前右心室起搏 QRS 宽度、植入前右心室起搏 QRS 轴类别、LV 起搏 QRS 宽度、植入后 QRS 轴类别、双心室（Bi-V）起搏与植入前 QRS 宽度的差值、QRS 束支形态特征进行了单变量分析，以预测结果。所有有意义的预测因素（α=0.1）、年龄和性别都用于多变量分析。还进行了心肌病病因的交互作用和亚组分析。在多变量分析中，只有 QRS 左束支形态特征预测了 CCS（比值比[OR]=2.46，P=0.02）和 LVESV（OR=2.89，P=0.048）的反应。Bi-V 和植入前 QRS 宽度的差值预测了 CCS 的改善（OR=0.89，P=0.04）。LV 起搏 QRS 宽度预测了 LVESV 的减少（OR=0.86，P=0.01）。具体而言，LV 起搏 QRS 宽度≤200ms 可预测非缺血性 LVESV 减少（OR=5.12，P=0.01）。
基线左束支 QRS 形态特征、LV 起搏 QRS 宽度和 Bi-V 与植入前 QRS 宽度的差值可预测 CRT 后的阳性结果，这可能代表一种新的术中方法，以优化冠状窦导联的放置。
