CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Heart Fail. 2014 Feb;16(2):227-34. doi: 10.1002/ejhf.38. Epub 2013 Dec 11.
The current study examined the degree of agreement between echocardiographic and patient-reported health status response to CRT 6 months after implantation, and evaluated the differences in pre-implantation characteristics of patients with concordant and discordant echocardiographic and health status responses.
Consecutively implanted CRT-defibrillator patients (n = 109, mean age = 65.4 ± 10.1 years, 74 men) were recruited from the University Medical Center Utrecht, The Netherlands. Prior to implantation and 6 months post-implantation, all patients underwent echocardiography and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Echocardiographic response was defined as a relative reduction of ≥15% in LV end-systolic volume; an improvement of ≥10 points in KCCQ score indicated a health status response. In the 54 patients with discordant responses, 25 (22.9%) had an echocardiographic response but no health status response and 29 (26.6%) had a health status response but no echocardiographic response. Patients with concordant and discordant responses differed on various pre-implantation characteristics, including sex, employment status, LV volumes, and pre-implantation KCCQ score. In multivariable analysis, pre-implantation KCCQ score [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.88-0.95, P < 0.001] and QRS duration (OR = 1.03, 95% CI = 1.01-1.06, P = 0.009) were the only characteristics associated with health status response to CRT.
Our results show a large discrepancy between echocardiographic and patient-reported health status response to CRT. The most important predictor of health status response was the pre-implantation health status score. These results emphasize that disease-specific health status measures may have additional value over 'objective' measures of CRT response and should be incorporated in clinical practice.
本研究旨在评估 CRT 植入后 6 个月时超声心动图与患者报告的健康状况之间的一致性程度，并评估具有一致性和不一致性超声心动图与健康状况反应的患者在植入前特征上的差异。
从荷兰乌得勒支大学医学中心连续招募 CRT 除颤器植入患者（n=109，平均年龄 65.4±10.1 岁，74 名男性）。在植入前和植入后 6 个月，所有患者均接受超声心动图检查并完成堪萨斯城心肌病问卷（KCCQ）。超声心动图反应定义为 LV 收缩末期容积相对减少≥15%；KCCQ 评分改善≥10 分表明健康状况有反应。在 54 例反应不一致的患者中，25 例（22.9%）有超声心动图反应但无健康状况反应，29 例（26.6%）有健康状况反应但无超声心动图反应。具有一致性和不一致性反应的患者在各种植入前特征上存在差异，包括性别、就业状况、LV 容积和植入前 KCCQ 评分。多变量分析显示，植入前 KCCQ 评分[比值比（OR）=0.91，95%置信区间（CI）=0.88-0.95，P<0.001]和 QRS 持续时间（OR=1.03，95%CI=1.01-1.06，P=0.009）是 CRT 对健康状况反应的唯一特征。
我们的结果表明，超声心动图与患者报告的 CRT 健康状况反应之间存在较大差异。健康状况反应的最重要预测因素是植入前的健康状况评分。这些结果强调，特定疾病的健康状况测量可能比 CRT 反应的“客观”测量具有额外的价值，应纳入临床实践。
