Liu Xi, Hu Yiran, Hua Wei, Yang Shengwen, Gu Min, Niu Hong-Xia, Ding Li-Gang, Wang Jing, Zhang Shu
State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Beijing 100070, China.
Cardiol Res Pract. 2020 Aug 28;2020:3856294. doi: 10.1155/2020/3856294. eCollection 2020.
It is important to identify super-responders who can derive most benefits from cardiac resynchronization therapy (CRT). We aimed to establish a scoring model that can be used for predicting super-response to CRT.
We retrospectively reviewed 387 CRT patients. Multivariate logistic regression analysis was performed to identify predictors for super-response (defined as an absolute increase in left ventricular ejection fraction of ≥15% at 6-month follow-up) and to create a score model. Multivariate Cox proportional-hazard regression analysis was conducted to assess associations with the long-term endpoint (defined as cardiac death/heart transplant, heart failure (HF) hospitalization, or all-cause death) across the score categories at follow-up.
Among 387 patients, 109 (28.2%) met super-response. In multivariable analysis, 5 independent predictors (QQ-LAE) were identified: prior no fragmented QRS (odds ratio (OR) = 3.10 (1.39, 6.94)), QRS duration ≥170 ms (OR = 2.37 (1.35, 4.12)), left bundle branch block (OR = 2.57 (1.04, 6.37)), left atrial diameter <45 mm (OR = 3.27 (1.81, 5.89)), and left ventricular end-diastolic dimension <75 mm (OR = 4.11 (1.99, 8.48)). One point was attributed to each predictor, and three score categories were identified. The proportion of super-response after 6-month CRT implantation in patients with scores 0-3, 4, and 5 was 14.6%, 40.3%, and 64.1%, respectively ( < 0.001). Patients with score 5 had an 88% reduction in the risk of cardiac death/heart transplant (=0.042), a 71% reduction in the risk of HF hospitalization (=0.048), and an 89% reduction in the risk of all-cause mortality (=0.028) compared to patients with scores 0-3.
The QQ-LAE score can be used for prediction of super-response to CRT and selection of most suitable patients in clinical practices.
识别能从心脏再同步治疗（CRT）中获得最大益处的超级反应者很重要。我们旨在建立一个可用于预测CRT超级反应的评分模型。
我们回顾性分析了387例CRT患者。进行多变量逻辑回归分析以确定超级反应（定义为随访6个月时左心室射血分数绝对增加≥15%）的预测因素，并创建一个评分模型。进行多变量Cox比例风险回归分析，以评估随访时各评分类别与长期终点（定义为心源性死亡/心脏移植、心力衰竭（HF）住院或全因死亡）的相关性。
在387例患者中，109例（28.2%）达到超级反应。在多变量分析中，确定了5个独立预测因素（QQ-LAE）：既往无碎裂QRS波（比值比（OR）=3.10（1.39，6.94））、QRS波时限≥170 ms（OR=2.37（1.35，4.12））、左束支传导阻滞（OR=2.57（1.04，6.37））、左心房直径<45 mm（OR=3.27（1.81，5.89））和左心室舒张末期内径<75 mm（OR=4.11（1.99，8.48））。每个预测因素赋予1分，并确定了三个评分类别。评分0 - 3分、4分和5分的患者在植入CRT 6个月后的超级反应比例分别为14.6%、40.3%和64.1%（<0.001）。与评分0 - 3分的患者相比，评分5分的患者心源性死亡/心脏移植风险降低88%（=0.042），HF住院风险降低71%（=0.048），全因死亡率风险降低89%（=0.028）。
QQ-LAE评分可用于预测CRT的超级反应，并在临床实践中选择最合适的患者。
