Killu Ammar M, Grupper Avishay, Friedman Paul A, Powell Brian D, Asirvatham Samuel J, Espinosa Raul E, Luria David, Rozen Guy, Buber Jonathan, Lee Ying-Hsiang, Webster Tracy, Brooke Kelly L, Hodge David O, Wiste Heather J, Glikson Michael, Cha Yong-Mei
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
J Card Fail. 2014 Jun;20(6):379-86. doi: 10.1016/j.cardfail.2014.03.001. Epub 2014 Mar 12.
Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit.
In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6-15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (-0.9 ± 0.9 vs -0.4 ± 0.8 [P < .001] and -0.6 ± 0.8 [P = .02]) and LVEDD (-8.7 ± 9.9 mm vs -0.5 ± 5.0 and -2.4 ± 5.8 mm [P < .001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- (P < .001) and moderate-responders (P = .049).
Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.
心脏再同步治疗（CRT）已被证明可改善心力衰竭（HF）症状并提高生存率。我们假设CRT后左心室射血分数（LVEF）的更大改善与更大的生存获益相关。
在2个国际中心的693例患者中，确定了CRT后LVEF的改善情况。患者被分为CRT的无反应/轻度反应者、中度反应者或超反应者，分别定义为LVEF的绝对变化≤5%、6 - 15%和>15%。评估了每组纽约心脏协会（NYHA）功能分级和左心室舒张末期内径（LVEDD）的变化。有395例无反应/轻度反应者、186例中度反应者和112例超反应者。与无反应/轻度反应者和中度反应者相比，超反应者更可能为女性，患有非缺血性心肌病，肌酐水平较低，肺动脉收缩压较低。超反应者的LVEF也比无反应/轻度反应者更低。各组之间在NYHA功能分级、二尖瓣反流分级或三尖瓣反流分级方面没有差异。超反应者的NYHA功能分级改善最大（-0.9 ± .9 vs -0.4 ± 0.8 [P <.001]和-0.6 ± 0.8 [P = .02]），LVEDD改善也最大（-8.7 ± 9.9 mm vs -0.5 ± 5.0和-2.4 ± 5.8 mm [两者均P <.001]）。Kaplan-Meier生存分析显示，与无反应/轻度反应者（P <.OO1）和中度反应者（P = .049）相比，超反应者的生存率更高。
CRT后HF症状的改善和生存率与左心室收缩功能的改善程度成正比。女性、具有非缺血性基质者和肺动脉收缩压较低者更可能出现超反应。
