Coppola Giuseppe, Ciaramitaro Gianfranco, Stabile Giuseppe, DOnofrio Antonio, Palmisano Pietro, Carità Patrizia, Mascioli Giosuè, Pecora Domenico, De Simone Antonio, Marini Massimiliano, Rapacciuolo Antonio, Savarese Gianluca, Maglia Giampiero, Pepi Patrizia, Padeletti Luigi, Pierantozzi Attilio, Arena Giuseppe, Giovannini Tiziana, Caico Salvatore Ivan, Nugara Cinzia, Ajello Laura, Malacrida Maurizio, Corrado Egle
U.O.C. di Cardiologia, Policlinico Universitario "Paolo Giaccone", Palermo, Italy.
U.O.C. di Cardiologia, Policlinico Universitario "Paolo Giaccone", Palermo, Italy.
Int J Cardiol. 2016 Oct 15;221:450-5. doi: 10.1016/j.ijcard.2016.06.203. Epub 2016 Jul 1.
Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation.
We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response.
Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
多项研究探讨了固有QRS时限（QRSd）或QRS变窄与双心室起搏反应之间的关联。然而，它们的结果相互矛盾。我们研究的目的是确定QRS变窄指数（QI）的相对变化与接受心脏再同步治疗（CRT）植入患者的临床结局和预后之间的关联。
我们纳入了311例根据当前CRT指南植入CRT设备的患者。植入时，测量固有QRS、CRT期间的QRSd和QI。6个月后，220例（71%）患者的左室舒张末期容积（LVESV）减少了10%。QI的中位数[第25-75百分位数]为14.3%[7.2-21.4]，且与逆向重构显著相关（r=+0.22；95%置信区间：0.11-0.32，p=0.0001）。CRT治疗6个月后最能预测左室逆向重构的QI临界值为12.5%（敏感性=63.6%，特异性=57.1%，曲线下面积=0.633，p=0.0002）。QI>12.5%的患者发生死亡或心血管住院事件的时间显著更长（对数秩检验，p=0.0155），风险比（HR）为0.3[95%置信区间：0.11-0.78]。在针对基线参数进行调整的多变量回归模型中，QI增加10%（HR=0.61[0.44-0.83]，p=0.002）仍与CRT反应显著相关。
CRT启动后QRSd下降幅度更大的患者表现出更大程度的超声心动图逆向重构，且死亡或心血管住院的结局更好。QI是一个易于测量的变量，可用于在起搏部位选择或起搏配置编程时预测CRT反应。
