Cardiovascular Department, University and 'Ospedali Riuniti di Trieste' Hospital, Via Valdoni, 7, 34129 Trieste, Italy.
Europace. 2014 Mar;16(3):363-71. doi: 10.1093/europace/eut339. Epub 2013 Nov 4.
To evaluate the long-term changes of clinical and echocardiographic parameters, the incidence of cardiac events and parameters associated with late cardiac events in 'super-responders' to cardiac resynchronization therapy (CRT) with [CRT defibrillator (CRT-D)] or without defibrillator back-up.
In all consecutive patients treated with CRT in two Italian centres (Trieste and Udine) with left ventricular ejection fraction (LVEF) ≤0.35 at implantation (Timp) and LVEF > 0.50 1 and/or 2 years (Tnorm) after implantation, the long-term outcome and the evolution of echocardiographic parameters were assessed; factors associated with a higher risk of cardiac events, defined as hospitalization or death for heart failure (HF), sudden death, or CRT-D appropriate interventions, were also analysed. Among the 259 patients evaluated, 62 (24%) had LVEF ≥ 0.50 at Tnorm (n = 44 with at 1 year, n = 18 at 2 years). During a mean follow-up of 68 ± 30 months, one cardiac death (for HF) and eight cardiovascular events (two hospitalization for HF and six appropriate CRT-D interventions) occurred. At the last echo evaluation (Tfup) performed 51 ± 26 months after Timp, LVEF was <0.50 in five patients (>0.45 in four of them). At univariable analysis, only LV end-systolic volume evaluated at Tfup was associated with a higher risk of cardiac events during follow-up.
In 'super-responders' to CRT long-term outcome is excellent. However, cardiac events, mainly CRT-D appropriate interventions, can occur despite the persistence of LVEF > 0.50. Early identification of these patients is still an unsolved issue.
评估心脏再同步治疗（CRT）“超级应答者”的临床和超声心动图参数的长期变化、心脏事件的发生率以及与晚期心脏事件相关的参数，这些患者使用的 CRT 设备带有（CRT-D）或不带有除颤器后备。
在意大利的两个中心（的里雅斯特和乌迪内）连续接受 CRT 治疗的所有患者中，在植入时（Timp）左心室射血分数（LVEF）≤0.35，植入后 1 年（Tnorm）和/或 2 年（Tnorm）LVEF>0.50，评估长期预后和超声心动图参数的演变；还分析了与更高心脏事件风险相关的因素，定义为心力衰竭（HF）住院或死亡、心脏性猝死或 CRT-D 适当干预。在评估的 259 例患者中，62 例（24%）在 Tnorm 时 LVEF≥0.50（n=44 例在 1 年时，n=18 例在 2 年时）。在平均 68±30 个月的随访期间，发生 1 例心脏死亡（HF 所致）和 8 例心血管事件（HF 住院治疗 2 例，CRT-D 适当干预 6 例）。在 Timp 后 51±26 个月进行的最后一次超声心动图评估（Tfup）时，5 例患者的 LVEF<0.50（其中 4 例>0.45）。在单变量分析中，仅在 Tfup 时评估的 LV 收缩末期容积与随访期间发生心脏事件的风险较高相关。
在 CRT 的“超级应答者”中，长期预后良好。然而，尽管 LVEF>0.50 持续存在，仍可发生心脏事件，主要是 CRT-D 适当干预。早期识别这些患者仍然是一个悬而未决的问题。
