I.U. Matemática Pura y Aplicada, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain.
Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
Med Biol Eng Comput. 2018 Apr;56(4):611-621. doi: 10.1007/s11517-017-1711-1. Epub 2017 Aug 24.
Cardiac resynchronization therapy (CRT) is an effective treatment for those patients with severe heart failure. Regrettably, there are about one third of CRT "non-responders", i.e. patients who have undergone this form of device therapy but do not respond to it, which adversely affects the utility and cost-effectiveness of CRT. In this paper, we assess the ability of a novel surface ECG marker to predict CRT response. We performed a retrospective exploratory study of the ECG previous to CRT implantation in 43 consecutive patients with ischemic (17) or non-ischemic (26) cardiomyopathy. We extracted the QRST complexes (consisting of the QRS complex, the S-T segment, and the T wave) and obtained a measure of their energy by means of spectral analysis. This ECG marker showed statistically significant lower values for non-responder patients and, joint with the duration of QRS complexes (the current gold-standard to predict CRT response), the following performances: 86% accuracy, 88% sensitivity, and 80% specificity. In this manner, the proposed ECG marker may help clinicians to predict positive response to CRT in a non-invasive way, in order to minimize unsuccessful procedures.
心脏再同步治疗（CRT）是治疗严重心力衰竭患者的有效方法。遗憾的是，约有三分之一的 CRT“无应答者”，即接受了这种设备治疗但没有应答的患者，这对 CRT 的实用性和成本效益产生了不利影响。在本文中，我们评估了一种新型体表心电图标志物预测 CRT 反应的能力。我们对 43 例连续的缺血性（17 例）或非缺血性（26 例）心肌病患者 CRT 植入前的心电图进行了回顾性探索性研究。我们提取了 QRST 复合体（由 QRS 复合体、S-T 段和 T 波组成），并通过频谱分析获得了它们能量的度量。对于无应答者，这个心电图标志物显示出统计学上显著更低的值，并且与 QRS 复合体的持续时间（预测 CRT 反应的当前金标准）一起，具有以下性能：86%的准确率、88%的灵敏度和 80%的特异性。通过这种方式，所提出的心电图标志物可以帮助临床医生以非侵入性的方式预测 CRT 的阳性反应，以尽量减少不成功的手术。
