Płońska-Gościniak Edyta, Kasprzak Jarosław D, Kukulski Tomasz, Mizia-Stec Katarzyna, Nowalany-Kozielska Ewa, Gąsior Zbigniew, Wita Krystian, Sinkiewicz Władysław, Szwed Hanna, Gościniak Piotr, Chrzanowski Łukasz
Pol Arch Med Wewn. 2016 Dec 12;126(12):989-994. doi: 10.20452/pamw.3715.
INTRODUCTION The response to Cardiac Resynchronisation Therapy (CRT) varies significantly, resulting in lack of improvement among the substantial patients proportion. OBJECTIVES To identify mechanical dyssynchrony indices with combination of myocardial viability characteristics for predicting long-term response to CRT. PATIENTS AND METHODS ViaCRT was a multicentre study coordinated by the Working Group on Echocardiography of Polish Cardiac Society. 127 patients with heart failure were assessed prospectively. Cardiac dyssynchrony indices and low-dose dobutamine response were determined by echocardiography prior to CRT. Improvement in Wall Motion Score Index (WMSI) or LVEF exceeding 20% at peak stress identified preserved contractile reserve. RESULTS After 12 months there was significantly different survival between subsets with and without viability characterised by WMSI decrease, corresponding to 1 (4.4%) and 20 (19.4%) fatal events respectively (p=0.048). The predictive value of LVEF gain at Dobutamine Stress Echocardiography (DSE) study was only significant at 6 months, with all-cause death occurring in 1 (1.6%) and 7 (12.1%) of patients with viable and non-viable myocardium respectively (p=0.029). Multivariate regression analysis identified the presence of septal flash and interventricular dyssynchrony as independent indices with the ability to predict echocardiographic response alone at 12 months. CONCLUSIONS The study demonstrated a significant relationship between left ventricular contractile reserve at DSE and long-term all-cause mortality following CRT device implantation. Conversely, the presence of septal flash and interventricular dyssynchrony but not myocardial viability were predictive of the response to resynchronisation. The results indicate that interference of multiple different mechanisms may be responsible for the general effect following CRT.
心脏再同步治疗（CRT）的反应差异显著，导致相当一部分患者并无改善。
结合心肌存活特征识别机械不同步指标，以预测CRT的长期反应。
ViaCRT是由波兰心脏病学会超声心动图工作组协调的一项多中心研究。前瞻性评估了127例心力衰竭患者。在CRT治疗前通过超声心动图测定心脏不同步指标和低剂量多巴酚丁胺反应。壁运动评分指数（WMSI）改善或峰值应力时左室射血分数（LVEF）增加超过20%表明保留收缩储备。
12个月后，以WMSI降低为特征的有存活能力和无存活能力亚组之间的生存率有显著差异，分别对应1例（4.4%）和20例（19.4%）死亡事件（p=0.048）。多巴酚丁胺负荷超声心动图（DSE）研究中LVEF增加的预测价值仅在6个月时显著，有存活心肌和无存活心肌的患者全因死亡分别发生1例（1.6%）和7例（12.1%）（p=0.029）。多变量回归分析确定室间隔闪烁和心室间不同步的存在是独立指标，能够单独预测12个月时的超声心动图反应。
该研究表明DSE时左室收缩储备与CRT装置植入后的长期全因死亡率之间存在显著关系。相反，室间隔闪烁和心室间不同步的存在而非心肌存活能力可预测再同步反应。结果表明多种不同机制的干扰可能是CRT后总体效果的原因。
