Ghossein Mohammed Ali, Zanon Francesco, Salden Floor, van Stipdonk Antonius, Marcantoni Lina, Engels Elien, Luermans Justin, Westra Sjoerd, Prinzen Frits, Vernooy Kevin
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
Santa Maria Della Misericordia General Hospital, 45100 Rovigo, Italy.
J Clin Med. 2021 Dec 17;10(24):5935. doi: 10.3390/jcm10245935.
: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. : Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dt). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dt were studied in relation to different LV pacing locations within a patient. : Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dt than anterior or posterior pacing ( = 0.0007). A similar trend was found for ∆QRS area ( = 0.001) but not for ∆QRS duration ( = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dt ( = 0.004), and ∆QRS area ( = 0.003) but not ∆QRS duration ( = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dt was 0.76 (median, IQR 0.35; 0,89). : Within patients, ∆QRS area is associated with %∆LVdP/dt at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.
心脏再同步治疗（CRT）后QRS波面积缩小与长期临床预后改善相关。本研究旨在探讨QRS波面积缩小是否与通过不同左心室（LV）部位起搏的血流动力学改善相关，以及是否可用于指导LV导联放置。：前瞻性纳入来自三家医院的有Ia/IIa类CRT指征的患者。急性血流动力学反应评估为左心室（LV）压力最大上升速率的相对变化（%∆LVdP/dt）。研究了患者体内不同LV起搏部位的QRS波面积变化（∆QRS面积）、QRS波时限变化（∆QRS时限）和%∆LVdP/dt。：对在188个不同LV起搏部位进行起搏的52例患者的数据进行了研究。LV侧壁起搏导致的%∆LVdP/dt大于前壁或后壁起搏（P = 0.0007）。∆QRS面积也有类似趋势（P = 0.001），但∆QRS时限无此趋势（P = 0.23）。从近端电极对起搏导致更大的%∆LVdP/dt（P = 0.004）和∆QRS面积（P = 0.003），但∆QRS时限无变化（P = 0.77）。在患者体内，∆QRS面积与%∆LVdP/dt之间的相关性为0.76（中位数，IQR 0.35；0.89）。：在患者体内，不同LV起搏部位的∆QRS面积与%∆LVdP/dt相关。因此，QRS波面积是一个易于、无创获得且客观的参数，可能有助于指导CRT中LV导联的放置。
