Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Heart Rhythm. 2018 Jan;15(1):130-136. doi: 10.1016/j.hrthm.2017.08.021. Epub 2017 Aug 24.
An ischemic etiology of heart failure (HF) has been associated with reduced left ventricular reverse remodeling after cardiac resynchronization therapy (CRT).
The purpose of this study was to assess the relationship between the etiology of HF and reverse remodeling and outcome after CRT.
Consecutive patients undergoing CRT implantation between October 1, 2008 and August 14, 2015 were retrospectively evaluated. Coronary angiography classified ischemic vs nonischemic etiology. Reverse remodeling was defined as the changes in left ventricular ejection fraction (LVEF) after 6 months. Clinical outcome was assessed 1 year after implantation using a combined end point of all-cause mortality and HF readmission.
A total of 685 patients were included (300/385 for ischemic/nonischemic etiology). Compared with patients with ischemic cardiomyopathy, patients with nonischemic cardiomyopathy exhibited a greater degree of improvement in LVEF (8.4% ± 10.4% vs 15.8% ± 12.3%; P < .001). After correcting for differences, an ischemic etiology of HF predicted less reverse remodeling (P < .001) and a higher rate of mortality or HF readmission (hazard ratio 1.63; 95% confidence interval [CI] 1.12-2.73; P = .011). Nevertheless, in comparison to a greater degree of improvement in LVEF, a lesser degree of improvement in LVEF (0%-5%) was associated with a higher risk of all-cause mortality and HF hospitalization in patients with nonischemic cardiomyopathy (odds ratio 9.78; 95% CI 1.95-49.04; P = .006) but not in patients with ischemic cardiomyopathy (odds ratio 3.58; 95% CI 0.85-15.18; P = .083). The most accurate cutoff for improvement in LVEF predicting good clinical outcome was 5.5% in ischemic cardiomyopathy vs 10.5% in nonischemic cardiomyopathy.
CRT results in reverse remodeling in both patients with ischemic and nonischemic cardiomyopathy, but to a lesser extent in the former. Patients with an ischemic etiology are at an intrinsically higher risk of mortality and HF hospitalization, but derive benefit on outcome at a lesser degree of reverse remodeling.
心力衰竭（HF）的缺血性病因与心脏再同步治疗（CRT）后左心室反向重构减少有关。
本研究旨在评估 HF 病因与 CRT 后反向重构和结局的关系。
回顾性评估 2008 年 10 月 1 日至 2015 年 8 月 14 日期间接受 CRT 植入的连续患者。冠状动脉造影将病因分为缺血性与非缺血性。反向重构定义为 6 个月后左心室射血分数（LVEF）的变化。植入后 1 年使用全因死亡率和 HF 再入院的联合终点评估临床结局。
共纳入 685 例患者（缺血性/非缺血性病因各 300/385 例）。与缺血性心肌病患者相比，非缺血性心肌病患者的 LVEF 改善程度更大（8.4%±10.4%比 15.8%±12.3%；P<0.001）。在纠正差异后，HF 的缺血性病因预测反向重构程度较低（P<0.001）和死亡率或 HF 再入院率较高（风险比 1.63；95%置信区间[CI] 1.12-2.73；P=0.011）。然而，与 LVEF 改善程度相比，非缺血性心肌病患者 LVEF 改善程度较小（0%-5%）与全因死亡率和 HF 住院风险升高相关（比值比 9.78；95%CI 1.95-49.04；P=0.006），但在缺血性心肌病患者中则不然（比值比 3.58；95%CI 0.85-15.18；P=0.083）。预测良好临床结局的 LVEF 改善最佳截断值在缺血性心肌病中为 5.5%，而非缺血性心肌病中为 10.5%。
CRT 可导致缺血性和非缺血性心肌病患者发生反向重构，但前者程度较小。缺血性病因患者的死亡率和 HF 住院风险较高，但在反向重构程度较小的情况下，可从结局中获益。
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