Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
Pacemaker Center, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia.
Eur Heart J Cardiovasc Imaging. 2014 Dec;15(12):1344-9. doi: 10.1093/ehjci/jeu136. Epub 2014 Jul 22.
The aim of the study was to assess the value of coronary flow reserve (CFR) for predicting improvement of left ventricular function after cardiac resynchronization therapy (CRT).
Study population included 40 patients (mean age 58 ± 9 years) with heart failure (ejection fraction 25, 7 ± 5, 4%) and QRS duration of 158 ± 22 ms, planned for CRT. Before and after CRT implantation, CFR was measured non-invasively during hyperaemia induced with adenosine. Responders were defined by decrease in end-systolic volume ≥15%. Follow-up echocardiography and CFR measurements were obtained after 6 months. At baseline there was no significant difference in left ventricular ejection fraction (LVEF), QRS duration, 6 min walk test distance and coronary flow velocity at rest between responder (n = 26) vs. non-responder group (n = 14, P = ns). Before CRT implantation, responders compared with non-responders, showed a greater increase in coronary flow velocity during hyperaemia, and consequently higher CFR: 2.41 ± 0.60 vs. 1.61 ± 0.45 (P = 0.001). There was significant correlation between CFR before CRT implantation and LVEF after 6 months (r = 0.545, P = 0.001). End-diastolic, end-systolic left ventricular diameter, and CFR before CRT were predictors of LV functional improvement. By multivariate analysis, only CFR before CRT was independent predictor of left ventricular recovery in the follow-up period (P = 0.001).
Our results demonstrate that preserved CFR in patients with dilated cardiomyopathy is predictive of left ventricular improvement after CRT implantation.
本研究旨在评估冠状动脉血流储备（CFR）在预测心脏再同步化治疗（CRT）后左心室功能改善中的价值。
研究人群包括 40 名（平均年龄 58 ± 9 岁）心力衰竭患者（射血分数 25 ± 5%，QRS 持续时间 158 ± 22 ms），计划进行 CRT。在 CRT 植入前后，通过腺苷诱导的充血状态下非侵入性测量 CFR。以左心室收缩末期容积减少≥15%定义为反应者。在 6 个月后进行超声心动图和 CFR 随访测量。在基线时，反应者（n = 26）与无反应者（n = 14）之间，左心室射血分数（LVEF）、QRS 持续时间、6 分钟步行试验距离和静息时冠状动脉血流速度无显著差异（P = ns）。在 CRT 植入前，与无反应者相比，反应者在充血期间冠状动脉血流速度的增加更大，因此 CFR 更高：2.41 ± 0.60 vs. 1.61 ± 0.45（P = 0.001）。在 CRT 植入前的 CFR 与 6 个月后的 LVEF 之间存在显著相关性（r = 0.545，P = 0.001）。舒张末期、收缩末期左心室直径和 CRT 前的 CFR 是 LV 功能改善的预测因子。通过多变量分析，只有 CRT 前的 CFR 是随访期间左心室恢复的独立预测因子（P = 0.001）。
我们的研究结果表明，扩张型心肌病患者的 CFR 正常预示着 CRT 植入后左心室功能的改善。
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