Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Heart Rhythm. 2020 Nov;17(11):1887-1896. doi: 10.1016/j.hrthm.2020.05.036. Epub 2020 Jun 1.
Reliable quantitative preimplantation predictors of response to cardiac resynchronization therapy (CRT) are needed.
We tested the utility of preimplantation R-wave and T-wave heterogeneity (RWH and TWH, respectively) compared to standard QRS complex duration in identifying mechanical super-responders to CRT and mortality risk.
We analyzed resting 12-lead electrocardiographic recordings from all 155 patients who received CRT devices between 2006 and 2018 at our institution and met class I and IIA American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines with echocardiograms before and after implantation. Super-responders (n=35, 23%) had ≥20% increase in left ventricular ejection fraction and/or ≥20% decrease in left ventricular end-systolic diameter and were compared with non-super-responders (n=120, 77%), who did not meet these criteria. RWH and TWH were measured using second central moment analysis.
Among patients with non-left bundle branch block (LBBB), preimplantation RWH was significantly lower in super-responders than in non-super-responders in 3 of 4 lead sets (P=.001 to P=.038) and TWH in 2 lead sets (both, P=.05), with the corresponding areas under the curve (RWH: 0.810-0.891, P<.001; TWH: 0.759-0.810, P≤.005). No differences were observed in the LBBB group. Preimplantation QRS complex duration also did not differ between super-responders and non-super-responders among patients with (P=.856) or without (P=.724) LBBB; the areas under the curve were nonsignificant (both, P=.69). RWH ≥ 420 μV predicted 3-year all-cause mortality in the entire cohort (P=.037), with a hazard ratio of 7.440 (95% confidence interval 1.015-54.527; P=.048); QRS complex duration ≥ 150 ms did not predict mortality (P=.27).
Preimplantation interlead electrocardiographic heterogeneity but not QRS complex duration predicts mechanical super-response to CRT in patients with non-LBBB.
需要可靠的定量植入前预测因子来预测心脏再同步治疗（CRT）的反应。
我们测试了植入前 R 波和 T 波异质性（分别为 RWH 和 TWH）与标准 QRS 波群持续时间相比，在识别机械超应答者和死亡率风险方面的效用。
我们分析了在我们机构接受 CRT 设备的 155 名患者在植入前后的静息 12 导联心电图记录，这些患者均符合美国心脏病学会/美国心脏协会/心律协会 I 类和 IIA 类指南和超声心动图标准。超应答者（n=35，23%）左心室射血分数增加≥20%，或左心室收缩末期直径减少≥20%，与不符合这些标准的非超应答者（n=120，77%）进行比较。使用二阶中心矩分析测量 RWH 和 TWH。
在非左束支传导阻滞（LBBB）患者中，在 4 个导联组中的 3 个（P=.001 至 P=.038）和 2 个导联组中的 TWH（均为 P=.05）中，超应答者的植入前 RWH 明显低于非超应答者，相应的曲线下面积（RWH：0.810-0.891，P<.001；TWH：0.759-0.810，P≤.005）。在 LBBB 组中没有观察到差异。在有（P=.856）或没有（P=.724）LBBB 的患者中，超应答者和非超应答者之间的植入前 QRS 波群持续时间也没有差异；曲线下面积无显著性差异（均为 P=.69）。整个队列中，RWH≥420 μV 预测 3 年全因死亡率（P=.037），风险比为 7.440（95%置信区间 1.015-54.527；P=.048）；QRS 波群持续时间≥150 ms 不能预测死亡率（P=.27）。
在非 LBBB 患者中，植入前导联间心电图异质性而非 QRS 波群持续时间可预测 CRT 的机械超应答。
