Division of Cardiology, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy.
J Cardiovasc Med (Hagerstown). 2013 Apr;14(4):301-7. doi: 10.2459/JCM.0b013e328351f243.
Cardiac resynchronization therapy (CRT) is currently considered an important breakthrough in the treatment of selected patients with refractory heart failure. However, long-term predictors of mortality, morbidity and time to recovery of ventricular function for those patients who respond positively to CRT remain poorly investigated.
This is a retrospective follow-up study involving one hospital. Between August 2004 and October 2008, 211 consecutive patients with refractory heart failure received a CRT device in the Cardiology Division of Ospedale Civile Maggiore in Verona. The clinical characteristics studied were age, sex, heart rhythm, left ventricular end-systolic volume/body surface area (LVESV/BSA), left ventricular ejection fraction, QRS duration, type of bundle-branch block, cause, New York Heart Failure Association functional class, pharmacological therapy and lead position. The objective of this study was to evaluate the effect of several baseline characteristics on long-term prognosis in heart failure patients treated with CRT.
Nonischemic cause, left bundle-branch block and a basal LVESV/BSA of 106 ml/m or less were the only independent predictors of a positive response to CRT (P < 0.005). Additionally, a reduction in LVESV/BSA after CRT was associated both with increased survival and reduced rehospitalization for heart failure (P < 0.005).
A better selection of patients on the basis of cause, type of bundle-branch block and basal LVESV/BSA can increase the number of patients that would benefit from CRT.
心脏再同步治疗（CRT）目前被认为是治疗特定难治性心力衰竭患者的重要突破。然而，对于那些对 CRT 反应良好的患者，其死亡率、发病率和心室功能恢复时间的长期预测因素仍研究不足。
这是一项涉及一家医院的回顾性随访研究。2004 年 8 月至 2008 年 10 月，在维罗纳的 Civile Maggiore 医院心内科，211 例难治性心力衰竭患者连续接受 CRT 设备治疗。研究的临床特征包括年龄、性别、心律、左心室收缩末期容积/体表面积（LVESV/BSA）、左心室射血分数、QRS 持续时间、束支传导阻滞类型、病因、纽约心脏协会功能分级、药物治疗和导线位置。本研究的目的是评估 CRT 治疗心力衰竭患者的几种基线特征对长期预后的影响。
非缺血性病因、左束支传导阻滞和基础 LVESV/BSA 为 106ml/m 或更低是 CRT 反应阳性的唯一独立预测因素（P<0.005）。此外，CRT 后 LVESV/BSA 的降低与生存率的提高和心力衰竭再住院率的降低相关（P<0.005）。
基于病因、束支传导阻滞类型和基础 LVESV/BSA 更好地选择患者，可以增加从 CRT 中获益的患者数量。
