Ichibori Hirotoshi, Fukuzawa Koji, Kiuchi Kunihiko, Matsumoto Akinori, Konishi Hiroki, Imada Hiroshi, Hyogo Kiyohiro, Kurose Jun, Tatsumi Kazuhiro, Tanaka Hidekazu, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Pacing Clin Electrophysiol. 2017 Mar;40(3):301-309. doi: 10.1111/pace.13023. Epub 2017 Feb 14.
Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed.
We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period.
Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P < 0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093).
One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.
左心室收缩末期容积（LVESV）在6个月时的变化及临床状况有助于评估心脏再同步治疗（CRT）的疗效。CRT治疗后LVESV的消退情况在6个月后的研究尚未见报道。本研究旨在评估LVESV消退的反应者的比例、预测因素及临床结局。
我们回顾性分析了104例连续接受CRT治疗的患者。反应者定义为CRT治疗后6个月LVESV相对降低≥15%的患者。56例反应者参与了本研究。短暂反应者定义为CRT治疗后2年LVESV相对降低未≥15%或在24个月随访期内因心脏事件死亡的反应者。
56例反应者中，16例（29%）为短暂反应者。多变量逻辑回归分析显示，慢性房颤（比值比[OR]=19.2，95%置信区间[CI][1.93,190]，P=0.012）和使用胺碘酮（OR=60.9，95%CI[4.18,886]，P=0.003）是短暂反应的独立预测因素。在平均7.6年的随访期内，短暂反应者因心力衰竭住院的次数显著高于持续反应者（对数秩检验P<0.001），且短暂反应者的全因死亡率有升高趋势（对数秩检验P=0.093）。
CRT治疗后2年，三分之一的反应者为短暂反应者，其长期预后较差。应特别注意维持LVESV的降低，尤其是慢性房颤患者。
