Aston Medical School, Aston University, Birmingham, UK.
University Hospitals Birmingham, Birmingham, UK.
Pacing Clin Electrophysiol. 2022 Sep;45(9):1075-1084. doi: 10.1111/pace.14572. Epub 2022 Aug 9.
Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT.
In this retrospective study, we used CMR to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation.
Among 243 patients (age: 70.3 ± 10.8 years [mean ± SD]; 68.7% male; 121 [49.8%]) with ischemic cardiomyopathy and 122 (50.2%) with nonischemic cardiomyopathy, 141 (58%) after CRT-defibrillation (CRT-D) and 102 (42%) after CRT-pacing (CRT-P), 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from noncardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and four (1.64%) had a left ventricular assist device (LVAD). A total of 41 (16.9%) met the composite endpoint of sudden cardiac death (SCD), ventricular tachycardia, or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction.
There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection.
右心室（RV）功能障碍与心脏再同步治疗（CRT）反应不良有关。我们试图确定 CMR 衍生的 RV 功能测量值是否会影响 CRT 后的临床结果。
在这项回顾性研究中，我们使用 CMR 评估 RV 容积和 RV 射血分数（RVEF），以评估 CRT 植入后的临床结果。
在 243 名患有缺血性心肌病的患者（年龄：70.3±10.8 岁[平均值±标准差]；68.7%为男性；121 名[49.8%]）和 122 名患有非缺血性心肌病的患者中，141 名（58%）接受 CRT 除颤（CRT-D）治疗，102 名（42%）接受 CRT 起搏（CRT-P）治疗。在 5.87 年（中位数；四分位距：4.35-7.73）的随访期间，有 101 名（41.6.0%）患者死亡，61 名（25.1%）死于心脏原因，24 名（9.88%）死于非心脏原因。共有 41 名（16.9%）患者发生复合终点事件，包括心源性猝死（SCD）、室性心动过速或心室颤动。在单因素分析中，RV 功能的任何测量指标均与总死亡率或心律失常终点无关。RVEF 在单因素分析中与心脏死亡率相关（每增加 10%的 HR：0.82，95%CI：0.70-0.96），但在包括左心室射血分数的多因素分析中无相关性。
RV 功能的测量值（如 RV 容积和 RVEF）与 CRT 的长期临床结果之间没有关系。这些发现表明，在选择患者时不应考虑这些测量值。
