左心室机械不同步对不同病理生理心力衰竭患者 CRT 反应的预测价值。
Predictive values of left ventricular mechanical dyssynchrony for CRT response in heart failure patients with different pathophysiology.
机构信息
Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China.
出版信息
J Nucl Cardiol. 2022 Oct;29(5):2637-2648. doi: 10.1007/s12350-021-02796-3. Epub 2021 Sep 17.
BACKGROUND
Cardiac resynchronization therapy (CRT) patients with different pathophysiology may influence mechanical dyssynchrony and get different ventricular resynchronization and clinical outcomes.
METHODS
Ninety-two dilated cardiomyopathy (DCM) and fifty ischemic cardiomyopathy (ICM) patients with gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included in this retrospective study. Patients were classified based on the concordance between the left ventricular (LV) lead and the latest contraction or relaxation position. If the LV lead was located on or adjacent to both the latest contraction and relaxation position, the patient was categorized into the both match group; if the LV lead was located on or adjacent to the latest contraction or relaxation position, the patient was classified into the one match group; if the LV lead was located on or adjacent to neither the latest contraction nor relaxation position, the patient was categorized to the neither group. CRT response was defined as [Formula: see text] improvement of LV ejection fraction at the 6-month follow-up. Variables with P < .05 in the univariate analysis were included in the stepwise multivariate model.
RESULTS
During the follow-up period, 58.7% (54 of 92) for DCM patients and 54% (27 of 50) for ICM patients were CRT responders. The univariate analysis and stepwise multivariate analysis showed that QRS duration, systolic phase bandwidth (PBW), diastolic PBW, diastolic phase histogram standard deviation (PSD), and left ventricular mechanical dyssynchrony (LVMD) concordance were independent predictors of CRT response in DCM patients; diabetes mellitus and left ventricular end-systolic volume were significantly associated with CRT response in ICM patients. The intra-group comparison revealed that the CRT response rate was significantly different in the both match group of DCM (N = 18, 94%) and ICM (N = 24, 62%) patients (P = .016). However, there was no significant difference between DCM and ICM in the one match and neither group. For the inter-group comparison, Kruskal-Wallis H-test revealed that CRT response was significantly different in all the groups of DCM patients (P < .001), but not in ICM patients (P = .383).
CONCLUSIONS
Compared with ICM patients, systolic PBW, diastolic PBW and PSD have better predictive and prognostic values for the CRT response in DCM patients. Placing the LV lead in or adjacent to the latest contraction and relaxation position can improve the clinical outcomes of DCM patients, but it does not apply to ICM patients.
背景
心脏再同步治疗（CRT）患者的不同病理生理学可能影响机械不同步，并获得不同的心室再同步和临床结果。
方法
本回顾性研究纳入了 92 例扩张型心肌病（DCM）和 50 例缺血性心肌病（ICM）患者的门控单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）。根据左心室（LV）导联与最晚收缩或舒张位置的一致性对患者进行分类。如果 LV 导联位于最晚收缩和舒张位置之一或附近，则将患者归入两者匹配组；如果 LV 导联位于最晚收缩或舒张位置之一或附近，则将患者归入一个匹配组；如果 LV 导联既不在最晚收缩位置也不在最晚舒张位置，则将患者归入两者均不匹配组。CRT 反应定义为左心室射血分数在 6 个月随访时改善≥10%。单因素分析中 P <.05 的变量被纳入逐步多因素模型。
结果
在随访期间，58.7%（92 例中的 54 例）DCM 患者和 54%（50 例中的 27 例）ICM 患者为 CRT 反应者。单因素分析和逐步多因素分析显示，QRS 持续时间、收缩期带宽（PBW）、舒张期 PBW、舒张期直方图标准差（PSD）和左心室机械不同步（LVMD）一致性是 DCM 患者 CRT 反应的独立预测因素；糖尿病和左心室收缩末期容积与 ICM 患者的 CRT 反应显著相关。组内比较显示，DCM 中两者匹配组（N = 18，94%）和 ICM 中两者匹配组（N = 24，62%）的 CRT 反应率差异有统计学意义（P =.016）。然而，在 DCM 和 ICM 的一个匹配和两者均不匹配组之间没有显著差异。对于组间比较，Kruskal-Wallis H 检验显示，DCM 患者所有组的 CRT 反应均有显著差异（P <.001），但 ICM 患者无差异（P =.383）。
结论
与 ICM 患者相比，DCM 患者的收缩期 PBW、舒张期 PBW 和 PSD 对 CRT 反应具有更好的预测和预后价值。将 LV 导联置于或接近最晚收缩和舒张位置可改善 DCM 患者的临床结局，但不适用于 ICM 患者。
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