Nesti Martina, Perini Alessandro Paoletti, Bani Rossella, Cartei Stella, Checchi Luca, Ricciardi Giuseppe, Pieragnoli Paolo, Michelotti Federica, Mascioli Giosuè, Cavarretta Elena, Sciarra Luigi
Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, Italy.
Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Florence, Italy.
Cardiol Res Pract. 2020 Sep 21;2020:2036545. doi: 10.1155/2020/2036545. eCollection 2020.
Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE).
We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc.
SSc ≥7 was significantly associated with the absence of echocardiographic response to CRT (OR: 0.327; 95% C.I. 0.155-0.689; =0.003), while the presence of fQRS at baseline ECG was not (OR: 1.133; 95% C.I. 0.539-2.381; =0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints.
In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up.
心肌瘢痕与植入心脏再同步化治疗（CRT）后的反应直接相关。心肌瘢痕的范围不仅可以通过心脏磁共振检测，还可以通过两种心电图评分来检测：碎裂QRS波（fQRS）和塞尔维斯特评分（SSc）。我们研究的目的是比较基线SSc和fQRS在预测一组真正左束支传导阻滞（LBBB）心力衰竭患者对CRT反应中的作用。作为次要终点，我们评估了这两种评分与全因死亡率、心源性死亡率、心力衰竭住院率、需要植入式心律转复除颤器（ICD）干预的室性心律失常以及主要不良心血管事件（MACE）之间的关联。
我们评估了178例连续的心力衰竭患者的fQRS和SSc，这些患者有严重的收缩功能障碍（左心室射血分数[LVEF]≤35%），尽管接受了最佳药物治疗，但纽约心脏协会（NYHA）心功能分级为II - III级，且为真正的LBBB。对CRT的反应定义为在6个月随访时LVEF至少提高10%或左心室舒张末期容积（LVESV）至少降低15%。每个终点都与fQRS和SSc相关。
SSc≥7与CRT后超声心动图无反应显著相关（比值比[OR]：0.327；95%置信区间[C.I.] 0.155 - 0.689；P = 0.003），而基线心电图存在fQRS则无此相关性（OR：1.133；95% C.I. 0.539 - 2.381；P = 0.742）。在SSc与全因死亡率、心源性死亡、室性心律失常、心力衰竭住院或MACE之间未发现相关性。在fQRS与所有次要终点之间也观察到类似结果。
在符合CRT标准的真正LBBB且LVEF≤35%的心力衰竭患者中，通过植入前心电图计算SSc评估的心肌瘢痕是多次调整后无反应的独立预测因素。在24个月随访时，SSc和fQRS均与全因死亡率、心源性死亡、室性心律失常或心力衰竭住院无关。
