Yufu Kunio, Kondo Hidekazu, Shinohara Tetsuji, Ishii Yumi, Yoshimura Seiichiro, Abe Ichitaro, Saito Shotaro, Fukui Akira, Okada Norihiro, Akioka Hidefumi, Teshima Yasushi, Nakagawa Mikiko, Takahashi Naohiko
Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan.
Heart Vessels. 2019 May;34(5):763-770. doi: 10.1007/s00380-018-1308-0. Epub 2018 Nov 27.
Cardiac resynchronization therapy (CRT) has been established as a treatment for patients with chronic heart failure (HF). We tested the hypothesis that assessment of coronary flow reserve (CFR) predicts the long-term outcome of CRT. The study consisted of 114 HF patients implanted with a CRT device for the treatment of advanced HF between April 2010 and April 2018. After excluding patients that withdrew from long-term follow-up and patients missing a baseline CFR measurement, we enrolled 53 eligible patients. CFR was determined non-invasively by transthoracic echocardiography. Based on the ROC curve for predicting the appearance of major adverse cerebral and cardiovascular events (MACCE), the level of preserved CFR was set at >1.35 in responders. Accurate follow-up information (mean 873 ± 498 days) was obtained in 23 patients with a preserved CFR (16 females; mean age 71 ± 7.9 years) and 11 patients with a depressed CFR (5 females; mean age, 73 ± 7.6 years) in responders. Kaplan-Meier survival analysis demonstrated that the depressed CFR group had a higher prevalence of MACCE than the preserved CFR group (log rank, 9.83; p = 0.0021). Multivariate analysis revealed that depressed CFR was associated with MACCE (hazard ratio 4.88, 95% confidence interval 1.13-26.5, p = 0.0329). Our results suggest that the assessment of CFR predicts the outcome in responders to CRT. Preservation of coronary circulation flow might underlie one of the mechanisms for a better response to CRT in responders.
心脏再同步治疗（CRT）已被确立为慢性心力衰竭（HF）患者的一种治疗方法。我们检验了冠状动脉血流储备（CFR）评估可预测CRT长期疗效的假设。该研究纳入了2010年4月至2018年4月期间因晚期HF接受CRT装置植入治疗的114例HF患者。在排除退出长期随访的患者和未进行基线CFR测量的患者后，我们纳入了53例符合条件的患者。通过经胸超声心动图非侵入性地测定CFR。根据预测主要不良脑和心血管事件（MACCE）出现的ROC曲线，将反应者中CFR保留水平设定为>1.35。在反应者中，对23例CFR保留的患者（16例女性；平均年龄71±7.9岁）和11例CFR降低的患者（5例女性；平均年龄73±7.6岁）获得了准确的随访信息（平均873±498天）。Kaplan-Meier生存分析表明，CFR降低组的MACCE患病率高于CFR保留组（对数秩检验，9.83；p=0.0021）。多变量分析显示，CFR降低与MACCE相关（风险比4.88，95%置信区间1.13-26.5，p=0.0329）。我们的结果表明，CFR评估可预测CRT反应者中的疗效。冠状动脉循环血流的保留可能是反应者对CRT反应更好的机制之一。
