Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic.
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
PLoS One. 2019 Jul 17;14(7):e0219966. doi: 10.1371/journal.pone.0219966. eCollection 2019.
The aim of this study was to investigate the predictors of long-term clinical outcome of heart failure (HF) patients who survived first year after initiation of cardiac resynchronization therapy (CRT).
This was a single-center observational cohort study of CRT patients implanted because of symptomatic HF with reduced ejection fraction between 2005 and 2013. Left ventricle (LV) diameters and ejection fraction, New York Heart Association (NYHA) class, and level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) were assessed at baseline and 12 months after CRT implantation. Their predictive power for long-term HF hospitalization and mortality, and cardiac and all-cause mortality was investigated.
A total of 315 patients with left bundle branch block or intraventricular conduction delay who survived >1 year after CRT implantation were analyzed in the current study. During a follow-up period of 4.8±2.1 years from CRT implantation, 35.2% patients died from cardiac (19.3%) or non-cardiac (15.9%) causes. Post-CRT LV ejection fraction and LV end-systolic diameter (either 12-month value or the change from baseline) were equally predictive for clinical events. For NT-proBNP, however, the 12-month level was a stronger predictor than the change from baseline. Both reverse LV remodeling and 12-month level of NT-proBNP were independent and comparable predictors of CRT-related clinical outcome, while NT-proBNP response had the strongest association with all-cause mortality. When post-CRT relative change of LV end-systolic diameter and 12-month level of NT-proBNP (dichotomized at -12.3% and 1230 ng/L, respectively) were combined, subgroups of very-high and very-low risk patients were identified.
The level of NT-proBNP and reverse LV remodeling at one year after CRT are independent and complementary predictors of future clinical events. Their combination may help to improve the risk stratification of CRT patients.
本研究旨在探讨心脏再同步治疗（CRT）后存活超过 1 年的心力衰竭（HF）患者的长期临床结局的预测因素。
这是一项 2005 年至 2013 年间因射血分数降低的症状性 HF 而植入 CRT 的单中心观察性队列研究。在 CRT 植入前后评估左心室（LV）直径和射血分数、纽约心脏协会（NYHA）分级和脑钠肽前体 N 端片段（NT-proBNP）水平。研究其对长期 HF 住院和死亡率、心脏和全因死亡率的预测能力。
本研究共分析了 315 例 CRT 植入后存活>1 年的左束支传导阻滞或室内传导延迟患者。在 CRT 植入后的 4.8±2.1 年随访期间，35.2%的患者死于心脏（19.3%）或非心脏（15.9%）原因。CRT 后 LV 射血分数和 LV 收缩末期直径（12 个月时的值或与基线相比的变化）对临床事件具有同等的预测价值。然而，对于 NT-proBNP，12 个月时的水平比从基线的变化更能预测。LV 逆重构和 12 个月时的 NT-proBNP 水平均为 CRT 相关临床结局的独立且可比的预测因素，而 NT-proBNP 反应与全因死亡率的相关性最强。当 CRT 后 LV 收缩末期直径的相对变化和 12 个月时的 NT-proBNP 水平（分别在-12.3%和 1230ng/L 处二分）结合时，确定了非常高和非常低风险患者的亚组。
CRT 后 1 年时的 NT-proBNP 水平和 LV 逆重构是未来临床事件的独立且互补的预测因素。它们的组合可能有助于改善 CRT 患者的风险分层。
