电和机械不同步的测量对于改善CRT反应的预测都至关重要。

Measurements of electrical and mechanical dyssynchrony are both essential to improve prediction of CRT response.

作者信息

Van't Sant J, Ter Horst I A H, Wijers S C, Mast T P, Leenders G E, Doevendans P A, Cramer M J, Meine M

机构信息

Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

J Electrocardiol. 2015 Jul-Aug;48(4):601-8. doi: 10.1016/j.jelectrocard.2015.01.015. Epub 2015 Feb 2.

DOI:10.1016/j.jelectrocard.2015.01.015

PMID:25754584

Abstract

INTRODUCTION

Predicting reverse remodeling after cardiac resynchronization therapy (CRT) remains challenging and different etiologies of heart failure might hamper identification of predictors.

OBJECTIVE

Assess the incremental value of mechanical dyssynchrony besides electrical dyssynchrony for predicting CRT response.

METHODS

227 patients (51% ischemic) received CRT. Response was defined as ≥15% left ventricular end systolic volume decrease after six months. Prediction models were developed comprising clinical parameters and electrical dyssynchrony (Model A), subsequently complemented with mechanical dyssynchrony (Model B). Models were compared by area under the receiver-operating curve (AUC), net reclassification index (NRI) and integrated discrimination improvement (IDI) for the complete cohort, ischemic (ICM) and non-ischemic (NICM) subpopulations.

RESULTS

Model B performed significantly better than Model A supported by AUC, NRI and IDI. Furthermore, model B significantly better predicted response for NICM than ICM.

CONCLUSION

Electrical dyssynchrony and mechanical dyssynchrony are essential to predict CRT response. Nevertheless, response prediction for ICM remains challenging.

摘要

引言

预测心脏再同步治疗（CRT）后的逆向重构仍然具有挑战性，心力衰竭的不同病因可能会妨碍预测指标的识别。

目的

评估除电不同步之外的机械不同步对预测CRT反应的增量价值。

方法

227例患者（51%为缺血性）接受了CRT治疗。反应定义为六个月后左心室收缩末期容积减少≥15%。开发了包含临床参数和电不同步的预测模型（模型A），随后补充了机械不同步（模型B）。通过受试者工作特征曲线下面积（AUC）、净重新分类指数（NRI）和综合鉴别改善（IDI）对整个队列、缺血性（ICM）和非缺血性（NICM）亚组的模型进行比较。