Institut Clínic Cardio-Vascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Department of Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
Institut Clínic Cardio-Vascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigacíon Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
JACC Clin Electrophysiol. 2018 Feb;4(2):181-189. doi: 10.1016/j.jacep.2017.11.020. Epub 2018 Feb 1.
The aim of this study was to compare patient response to cardiac resynchronization therapy (CRT) using fusion-optimized atrioventricular (AV) and interventricular (VV) intervals versus nominal settings.
The additional benefit obtained by AV- and VV-interval optimization in patients undergoing CRT remains controversial. Previous studies show short-term benefit in hemodynamic parameters; however, midterm randomized comparison between electrocardiogram optimization and nominal parameters is lacking.
A group of 180 consecutive patients with left bundle branch block treated with CRT were randomized to fusion-optimized intervals (FOI) or nominal settings. In the FOI group, AV and VV intervals were optimized according to the narrowest QRS, using fusion with intrinsic conduction. Clinical response was defined as an increase >10% in the 6-min walk test or an increment of 1 step in New York Heart Association functional class. The left ventricular (LV) remodeling was defined as >15% decrease in left ventricular end-systolic volume (LVESV) at 12-month follow-up. Additionally, patients with LVESV reduction >30% relative to baseline were considered super-responders; by contrast, negative responders had increased LVESV relative to baseline.
Participant characteristics included a mean age of 65 ± 10 years, 68% male, 37% with ischemic cardiomyopathy, LV ejection fraction 26 ± 7%, and QRS 180 ± 22 ms. Baseline QRS was shortened significantly more by FOI, compared with nominal settings (-56.55 ± 17.65 ms vs. -37.81 ± 22.07 ms, respectively; p = 0.025). At 12 months, LV reverse remodeling was achieved in a larger proportion of the FOI group (74% vs. 53% [odds ratio: 2.02 (95% confidence interval: 1.08 to 3.76)], respectively; p = 0.026). No significant differences were observed in clinical response (61% vs. 53% [odds ratio: 1.43 (95% confidence interval: 0.79 to 2.59)], respectively; p = 0.24).
Device optimization based on FOI achieves greater LV remodeling, compared with nominal settings. (ECG Optimization of CRT: Evaluation of Mid-Term Response [BEST]; NCT01439529).
本研究旨在比较使用融合优化的房室（AV）和室间（VV）间期与标准设置的心脏再同步治疗（CRT）患者的反应。
在接受 CRT 的患者中，AV 和 VV 间期优化可获得额外的益处，但仍存在争议。先前的研究显示，在血流动力学参数方面具有短期益处；然而，在心电图优化和标准参数的中期随机比较方面仍存在空白。
将 180 例接受 CRT 的左束支传导阻滞患者随机分为融合优化间隔（FOI）组或标准设置组。在 FOI 组中，根据最窄 QRS 利用固有传导进行优化 AV 和 VV 间期。临床反应定义为 6 分钟步行测试增加 >10%或纽约心脏协会功能分级增加 1 级。左心室（LV）重构定义为 12 个月随访时 LV 收缩末期容积（LVESV）减少 >15%。此外，LVESV 较基线减少 >30%的患者被认为是超应答者；相反，负应答者的 LVESV 较基线增加。
参与者的特征包括平均年龄 65 ± 10 岁，68%为男性，37%为缺血性心肌病，左心室射血分数 26 ± 7%，QRS 180 ± 22 ms。与标准设置相比，FOI 显著缩短了基线 QRS（-56.55 ± 17.65 ms 与 -37.81 ± 22.07 ms；p=0.025）。在 12 个月时，FOI 组实现 LV 反向重构的比例更高（74%与 53%[优势比：2.02（95%置信区间：1.08 至 3.76）]，p=0.026）。两组的临床反应无显著差异（61%与 53%[优势比：1.43（95%置信区间：0.79 至 2.59）]，p=0.24）。
与标准设置相比，基于 FOI 的设备优化可实现更大的 LV 重构。（ECG 优化 CRT：评估中期反应[BEST]；NCT01439529）。
