Oka Takafumi, Inoue Koichi, Tanaka Koji, Toyoshima Yuko, Isshiki Takaaki, Kimura Takeshi, Nobuyoshi Masakiyo, Shizuta Satoshi, Arita Takeshi, Fujii Satoki, Iwakura Katsuomi, Fujii Kenshi, Ando Kenji
Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
Int J Cardiol. 2017 Sep 15;243:340-346. doi: 10.1016/j.ijcard.2017.05.058. Epub 2017 May 12.
A subset of patients undergoing cardiac resynchronization therapy (CRT) for heart failure (HF) with severe left ventricular (LV) dysfunction experience only short-lived LV reverse remodeling. Little is known about the incidence and prognosis of this finding. We sought to identify predictors of a brief response and investigated the prognosis in a retrospective study.
A total of 528 patients from a Japanese multicenter database with full echocardiography datasets were enrolled. Follow-up was 3.4±1.3years. Based on relative reduction in LV end-systolic volume (LVESV) at 6months, we categorized patients as responders (reduction in LVESV ≥15%) and non-responders (NRs; reduction in LVESV <15%). Based on reduction in LVESV at 1-2years, responders were subdivided into long-lasting responders (reduction in LVESV ≥15%) and brief responders (reduction in LVESV <15%).
Of 328 responders, 50 (15%) were brief responders. Predictors of brief response were prior ventricular tachyarrhythmia, a non-left bundle-branch block (LBBB) intrinsic QRS pattern, and prior hospitalization for HF. The risk of all-cause death in brief responders was significantly lower than that in NRs (P=0.034) and tended to be higher than that in long-lasting responders (P=0.080).
Approximately 15% of responders were brief responders. Prior ventricular tachyarrhythmia, a non-LBBB pattern, and HF hospitalization were independent predictors of a brief response. Brief response was significantly associated with decreased risk of all-cause death compared with NRs and had a tendency toward increased risk of all-cause death compared with long-lasting responders.
一部分因心力衰竭（HF）伴严重左心室（LV）功能障碍而接受心脏再同步治疗（CRT）的患者仅经历短暂的左心室逆向重构。关于这一发现的发生率和预后知之甚少。我们试图在一项回顾性研究中确定短暂反应的预测因素并调查预后情况。
来自日本多中心数据库且有完整超声心动图数据集的528例患者被纳入研究。随访时间为3.4±1.3年。根据6个月时左心室收缩末期容积（LVESV）的相对减少情况，我们将患者分为反应者（LVESV减少≥15%）和无反应者（NRs；LVESV减少<15%）。根据1至2年时LVESV的减少情况，反应者又被细分为长期反应者（LVESV减少≥15%）和短暂反应者（LVESV减少<15%）。
在328例反应者中，50例（15%）为短暂反应者。短暂反应的预测因素为既往室性快速心律失常、非左束支传导阻滞（LBBB）型固有QRS波形态以及既往因HF住院。短暂反应者的全因死亡风险显著低于无反应者（P = 0.034），且有高于长期反应者的趋势（P = 0.080）。
约15%的反应者为短暂反应者。既往室性快速心律失常、非LBBB型以及HF住院是短暂反应的独立预测因素。与无反应者相比，短暂反应与全因死亡风险降低显著相关，与长期反应者相比，有全因死亡风险增加的趋势。
