Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Street, 111a, Tomsk, Russian Federation.
J Interv Card Electrophysiol. 2024 Nov;67(8):1851-1863. doi: 10.1007/s10840-024-01844-5. Epub 2024 Jun 19.
The left bundle branch block, nonischemic heart failure (HF) and female gender are the most powerful predictors of a super response to cardiac resynchronization therapy (CRT). It is important to identify super responders who can derive most benefits from CRT. We aimed to establish a predicting model that could be used for prognosis of a super response to CRT in short-term period.
Patients with QRS ≥ 130 ms, New York Heart Association (NYHA) II-III class of HF, left ventricle ejection fraction (LVEF) ≤ 35% and indications for CRT were included in the study. Before and 6 month after CRT the electrocardiography, echocardiography and cardiac scintigraphy were performed. The study's primary endpoint was the NYHA class improvement ≥ 1 and left ventricle end systolic volume decrease > 30% or LVEF improvement > 15% after 6 month CRT. Based on collected data, we developed a predictive model regarding a super response to CRT.
Of 49 (100.0%) patients, 32 (65.3%) had a super response to CRT. Patients with a super response were likelier to have a lower cardiac index (p = 0.007), higher rates of interventricular delay (IVD) (p = 0.003), phase standard deviation of left ventricle anterior wall (PSD LVAW) (p = 0.009) and ∆QRS (p = 0.02). Only IVD and PSD LVAW were independently associated with a super response to CRT in univariate and multivariate logistic regression. We created a logistic equation and calculated a cut-off value. The resulting ROC curve revealed a discriminative ability with AUC of 0.812 (sensitivity 90.62%; specificity 70.59%).
Our predictive model is able to distinguish patients with a super response to CRT.
左束支传导阻滞、非缺血性心力衰竭（HF）和女性是心脏再同步治疗（CRT）超强反应的最有力预测因素。重要的是要识别出能够从 CRT 中获得最大益处的超强反应者。我们旨在建立一个预测模型，用于预测短期 CRT 超强反应的预后。
纳入 QRS≥130ms、HF 纽约心脏协会（NYHA）II-III 级、左心室射血分数（LVEF）≤35%且有 CRT 适应证的患者。在 CRT 前和 6 个月后进行心电图、超声心动图和心脏闪烁显像。研究的主要终点是 CRT 后 6 个月 NYHA 心功能分级改善≥1 级和左心室收缩末期容积减少>30%或 LVEF 改善>15%。根据收集的数据，我们建立了一个关于 CRT 超强反应的预测模型。
49 例（100.0%）患者中，32 例（65.3%）对 CRT 有超强反应。对 CRT 有超强反应的患者更可能有较低的心指数（p=0.007）、更高的室间延迟（IVD）率（p=0.003）、左心室前壁相位标准差（PSD LVAW）（p=0.009）和 ∆QRS（p=0.02）。单变量和多变量逻辑回归分析表明，只有 IVD 和 PSD LVAW 与 CRT 的超强反应独立相关。我们创建了一个逻辑方程并计算了一个截断值。所得 ROC 曲线显示出具有 0.812 的区分能力（敏感性 90.62%；特异性 70.59%）。
我们的预测模型能够区分对 CRT 有超强反应的患者。
