Chen Kangyu, Su Hao, Xie Cuiping, Wang Qi, Yu Fei, Sun Qi, Zhu Hongjun, Yang Dongmei, Xu Jian, Yan Ji
Department of Cardiology, The Provincial Hospital Affiliated to Anhui Medical University.
Echocardiography Laboratory, The Provincial Hospital Affiliated to Anhui Medical University.
Int Heart J. 2018 Nov 28;59(6):1320-1326. doi: 10.1536/ihj.17-577. Epub 2018 Oct 25.
Cardiac resynchronization therapy (CRT) improves heart function and prognosis in third-degree atrioventricular block (AVB) patients with heart failure (HF). However, it is still unclear how to screen for appropriate patients before implantation. This study aimed to evaluate the value of using QRS duration to predict CRT efficacy.This study enrolled a total of 72 third-degree AVB patients with HF who received CRT implantation. The patients were divided into Groups A (QRS duration < 120 ms, 33 cases), B (120 ms ≤ QRS duration < 150 ms, 22 cases), and C (QRS duration ≥ 150 ms, 17 cases) according to their baseline QRS duration. The effects of different QRS durations on CRT efficacy were analyzed.The CRT response rate were 30.3%, 50.0%, and 76.5% in Groups A, B, and C, respectively (P = 0.008). The patients in the 3 groups showed significant changes in left ventricular (LV) end-diastolic volume, LV end-systolic volume, and LV ejection fraction over the baseline values at 12 months after the implantation (P < 0.05), with the greatest change observed in Group C. Survival analysis indicated statistically significant differences among Groups A, B, and C (P = 0.024). Multivariate logistic regression analysis suggested that QRS duration was an independent prognostic factor for CRT efficacy. Baseline QRS duration was associated with improved myocardial remodeling and reductions in the incidence rates of primary endpoint events.QRS ≥ 150 ms is an effective predictor of postoperative outcome in patients with third-degree AVB and HF treated with CRT.
心脏再同步治疗（CRT）可改善三度房室传导阻滞（AVB）合并心力衰竭（HF）患者的心脏功能和预后。然而，植入前如何筛选合适的患者仍不清楚。本研究旨在评估使用QRS波时限预测CRT疗效的价值。本研究共纳入72例接受CRT植入的三度AVB合并HF患者。根据基线QRS波时限将患者分为A组（QRS波时限<120 ms，33例）、B组（120 ms≤QRS波时限<150 ms，22例）和C组（QRS波时限≥150 ms，17例）。分析不同QRS波时限对CRT疗效的影响。A、B、C组的CRT反应率分别为30.3%、50.0%和76.5%（P = 0.008）。植入后12个月时，3组患者的左心室舒张末期容积、左心室收缩末期容积和左心室射血分数较基线值均有显著变化（P < 0.05），C组变化最大。生存分析表明，A、B、C组之间存在统计学显著差异（P = 0.024）。多因素逻辑回归分析表明，QRS波时限是CRT疗效的独立预后因素。基线QRS波时限与心肌重塑改善及主要终点事件发生率降低相关。QRS≥150 ms是接受CRT治疗的三度AVB合并HF患者术后预后的有效预测指标。
