预测缺血性心肌病患者心脏再同步治疗后长期预后的逆向重构最佳截断值
Optimal cut-off value of reverse remodeling to predict long-term outcome after cardiac resynchronization therapy in patients with ischemic cardiomyopathy.
作者信息
Sugano Akinori, Seo Yoshihiro, Yamamoto Masayoshi, Harimura Yoshie, Machino-Ohtsuka Tomoko, Ishizu Tomoko, Aonuma Kazutaka
机构信息
Cardiovascular Division, Graduate School of Comprehensive Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
出版信息
J Cardiol. 2017 Feb;69(2):456-461. doi: 10.1016/j.jjcc.2016.01.016. Epub 2016 Mar 2.
BACKGROUND
Whether the optimal cut-off value of left ventricular (LV) reverse remodeling is different in patients with ischemic cardiomyopathy (ICM) vs. non-ischemic cardiomyopathy (NICM) is unclear. This study aimed to clarify this value in patients with ICM and NICM.
METHODS AND RESULTS
LV reverse remodeling was defined as a reduction in LV end-systolic volume (LVESV) at 6 months after cardiac resynchronization therapy (CRT). The clinical endpoint was the combination of cardiac death and first hospitalization for worsening heart failure. Ninety-one of 372 patients had ICM. Event-free survival rates did not differ between ICM and NICM groups (66.8% vs. 78.9%; p=0.12). Receiver operating characteristics analysis revealed a 9% reduction in ESV as the optimal cut-off value to predict the composite endpoint in patients with ICM and a 15% reduction in patients with NICM. Multivariate analysis revealed that reductions in ESV of ≥15% and ≥9% were independent predictors of the composite endpoint, as were left bundle branch block (LBBB) and B-type natriuretic peptide (BNP) at 6 months after CRT. In combination with LBBB and BNP, reduction in ESV ≥9% had a higher, but not significant, C-statistics value than ESV ≥15% (0.854, 95% CI 0.729-0.940 vs. 0.801, 95% CI 0.702-0.908, p=0.07).
CONCLUSION
The optimal cut-off value of a reduction in LVESV was lower in patients with ICM than in patients with NICM.
背景
缺血性心肌病（ICM）患者与非缺血性心肌病（NICM）患者左心室（LV）逆向重构的最佳截断值是否不同尚不清楚。本研究旨在明确ICM和NICM患者的该值。
方法与结果
左心室逆向重构定义为心脏再同步治疗（CRT）后6个月时左心室收缩末期容积（LVESV）降低。临床终点为心源性死亡和因心力衰竭恶化首次住院的联合终点。372例患者中有91例患有ICM。ICM组和NICM组的无事件生存率无差异（66.8%对78.9%；p = 0.12）。受试者工作特征分析显示，ICM患者中ESV降低9%是预测复合终点的最佳截断值，NICM患者中为15%。多因素分析显示，CRT后6个月时ESV降低≥15%和≥9%是复合终点的独立预测因素，左束支传导阻滞（LBBB）和B型利钠肽（BNP）也是如此。与LBBB和BNP联合时，ESV降低≥9%的C统计值高于ESV≥15%，但差异无统计学意义（0.854，95%CI 0.729 - 0.940对0.801，95%CI 0.702 - 0.908，p = 0.07）。
结论
ICM患者LVESV降低的最佳截断值低于NICM患者。
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