van 't Sant J, Mast T P, Bos M M, Ter Horst I A, van Everdingen W M, Meine M, Cramer M J
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Neth Heart J. 2016 Jan;24(1):47-55. doi: 10.1007/s12471-015-0767-5.
Change in left ventricular end-systolic volume (∆LVESV) is the most frequently used surrogate marker in measuring response to cardiac resynchronisation therapy (CRT). We investigated whether ∆LVESV is the best measure to discriminate between a favourable and unfavourable outcome and whether this is equally applicable to non-ischaemic and ischaemic cardiomyopathy.
205 CRT patients (age 65 ± 12 years, 69 % men) were included. At baseline and 6 months echocardiographic studies, exercise testing and laboratory measurements were performed. CRT response was assessed by: ∆LVESV, ∆LV ejection fraction (LVEF), ∆ interventricular mechanical delay, ∆VO2 peak, ∆VE/VCO2, ∆BNP, ∆creatinine, ∆NYHA, and ∆QRS. These were correlated to the occurrence of major adverse cardiac events (MACE) between 6 and 24 months.
MACE occurred in 19 % of the patients (non-ischaemic: 13 %, ischaemic: 24 %). ∆LVESV remained the only surrogate marker for CRT response for the total population and patients with non-ischaemic cardiomyopathy, showing areas under the curve (AUC) of 0.69 and 0.850, respectively. For ischaemic cardiomyopathy, ∆BNP was the best surrogate marker showing an AUC of 0.66.
∆LVESV is an excellent surrogate marker measuring CRT response concerning long-term outcome for non-ischaemic cardiomyopathy. ∆LVESV is not suitable for ischaemic cardiomyopathy in which measuring CRT response remains difficult.
左心室收缩末期容积变化（∆LVESV）是测量心脏再同步治疗（CRT）反应时最常用的替代标志物。我们研究了∆LVESV是否是区分有利和不利结果的最佳指标，以及这是否同样适用于非缺血性和缺血性心肌病。
纳入205例CRT患者（年龄65±12岁，69%为男性）。在基线和6个月时进行超声心动图检查、运动测试和实验室测量。通过以下指标评估CRT反应：∆LVESV、∆左心室射血分数（LVEF）、∆心室间机械延迟、∆峰值摄氧量（∆VO2 peak）、∆每分钟通气量/二氧化碳排出量（∆VE/VCO2）、∆脑钠肽（∆BNP）、∆肌酐、∆纽约心脏协会（NYHA）分级和∆QRS波群。将这些指标与6至24个月期间主要不良心脏事件（MACE）的发生情况进行关联分析。
19%的患者发生了MACE（非缺血性：13%，缺血性：24%）。∆LVESV仍然是总体人群和非缺血性心肌病患者CRT反应的唯一替代标志物，曲线下面积（AUC）分别为0.69和0.850。对于缺血性心肌病，∆BNP是最佳替代标志物，AUC为0.66。
∆LVESV是评估非缺血性心肌病CRT长期疗效的优秀替代标志物。∆LVESV不适用于缺血性心肌病，在缺血性心肌病中测量CRT反应仍然困难。
