Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Europace. 2018 Feb 1;20(2):e1-e10. doi: 10.1093/europace/euw445.
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.
We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.
The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.
心脏再同步治疗（CRT）可降低伴有心室传导延迟的收缩性心力衰竭患者的发病率和死亡率。个体对 CRT 反应的变异性需要更好的患者选择。标志物和 CRT 反应（MARC）研究旨在研究与 CRT 反应相关的标志物。
我们前瞻性研究了 240 例患者的 11 项临床、11 项心电图、4 项超声心动图和 16 项血液生物标志物预测 CRT 反应的能力。通过 6 个月随访时左心室收缩末期容积指数（LVESVi）的降低来测量反应。使用连续标度上的对数线性回归来比较生物标志物与 LVESVi 变化之间的关系。单变量有意义的协变量被纳入多变量模型。最终模型用于构建反应评分。年龄为 67 ± 10 岁，63%为男性，46%为缺血性病因，左心室射血分数为 26 ± 8%，LVESVi 为 75 ± 31ml/m2，QRS 为 178 ± 23ms。6 个月时，LVESVi 降低至 58 ± 31ml/m2（相对减少 22 ± 24%），130 例患者（61%）LVESVi 减少≥15%。单变量分析中有 17 个参数与 LVESVi 变化显著相关。在最终模型中，年龄、QRSAREA（使用心向量图）和两个超声心动图标志物（室间机械延迟和心尖摆动）与反向心室重构的程度仍然显著相关。该 CAVIAR（CRT-年龄-心向量图 QRSAREA-室间机械延迟-心尖摆动）反应评分也预测了心力衰竭住院和全因死亡率评估的临床结局。
CAVIAR 反应评分可预测 CRT 后的反向重构程度，并可用于改善患者选择。临床试验：NCT01519908。
