Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
Department of Radiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
Eur J Heart Fail. 2016 Nov;18(11):1375-1382. doi: 10.1002/ejhf.605. Epub 2016 Jul 13.
Up to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing.
A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT.
Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate.
多达 30-45%的植入患者对 CRT 无反应。我们评估了“CRT 团队”的作用，使用心脏磁共振（CMR）和纵向心肌应变来确定目标区域，该区域定义为 LV 起搏的延迟最严重和最具活力的区域。
共纳入 100 名心力衰竭患者，分为两组。第 1 组为 50 例连续接受 CRT 并前瞻性纳入的患者。第 2 组（对照组）由 50 例根据标准临床实践植入 CRT 装置的患者组成，与第 1 组的年龄、性别和 LVEF 相匹配。患者在基线和 6 个月随访时进行评估。在第 1 组中，患者接受二维斑点追踪评估纵向心肌应变和 CMR 成像，以确定 LV 导联起搏的目标区域。CRT 的阳性反应定义为 6 个月随访时 LV 收缩末期容积减少≥15%。第 1 组共有 39 例（78%）患者被归类为 CRT 反应者，而第 2 组仅有 28 例（56%）患者为 CRT 反应者（P=0.019）。“CRT 团队”将 LV 起搏的目标区域确定为 30 例（60%）患者的侧区，12 例（24%）患者的前外侧或后外侧区。在 8 例（16%）患者中，目标区域远离侧区，在前区或后区。具有一致位置的患者对 CRT 的反应率最高（93.1%）。
多模态心脏成像作为 CRT 植入的指导，有助于提高反应率。
