Kader Nareen, Holm-Nielsen Liv Therese, Tayal Bhupendar, Riahi Sam, Sommer Anders, Nielsen Jens Cosedis, Kronborg Mads Brix, Stephansen Charlotte, Andersen Niels Holmark, Risum Niels, Søgaard Peter, Zaremba Tomas
Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Eur Heart J Imaging Methods Pract. 2023 Dec 20;1(2):qyad045. doi: 10.1093/ehjimp/qyad045. eCollection 2023 Sep.
Currently, electrical rather than mechanical parameters of delayed left ventricular (LV) activation are used for patient selection for cardiac resynchronization therapy (CRT). However, despite adhering to current guideline-based criteria, about one-third of heart failure (HF) patients fail to derive benefit from CRT. This study sought to investigate the prognostic survival significance of a recently introduced index of contractile asymmetry (ICA) based on the deformation of entire opposing LV walls in the context of selecting patients with HF and left bundle branch abnormality (LBBB) for CRT.
We analysed 367 patients with HF and LBBB undergoing CRT (31.6% females, 69 ± 9 years, ischaemic aetiology in 50.7%, LV ejection fraction 27 ± 6%). ICA was calculated using LV strain rate values from curved anatomical M-mode plots of apical 2D echocardiography images. The predictive value of ICA was assessed using Kaplan-Meier analysis and Cox proportional hazards models. During a median follow-up time of 5.54 years, death or cardiac transplantation occurred in 105 (28.6%) cases. Higher baseline ICA values in all apical views, particularly in the two-chamber view (ICA-2ch), were associated with increased event-free survival, and the unadjusted hazard ratio was 0.28 (95% confidence interval 0.18-0.46). Higher ICA-2ch (>0.319 s) consistently predicted survival across clinical subgroups and remained significant after covariate adjustment, while the event rate sharply increased in low ICA-2ch cases. Additionally, including ICA-2ch improved the predictive value of the multivariate risk model containing the typical LBBB pattern.
Pre-implant ICA suggests a quantitative prognostic threshold for both long-term survival and adverse outcomes following CRT implantation.
目前，心脏再同步治疗（CRT）的患者选择是基于左心室（LV）延迟激活的电学而非力学参数。然而，尽管遵循当前基于指南的标准，仍有大约三分之一的心力衰竭（HF）患者未能从CRT中获益。本研究旨在探讨一种最近引入的基于整个相对LV壁变形的收缩不对称指数（ICA）在选择HF和左束支传导异常（LBBB）患者进行CRT时的预后生存意义。
我们分析了367例接受CRT的HF和LBBB患者（女性占31.6%，年龄69±9岁，缺血性病因占50.7%，LV射血分数27±6%）。使用来自心尖二维超声心动图图像的曲线解剖M型图的LV应变率值计算ICA。使用Kaplan-Meier分析和Cox比例风险模型评估ICA的预测价值。在中位随访时间5.54年期间，105例（28.6%）患者发生死亡或心脏移植。所有心尖视图中较高的基线ICA值，特别是在两腔视图（ICA-2ch）中，与无事件生存率增加相关，未调整的风险比为0.28（95%置信区间0.18-0.46）。较高的ICA-2ch（>0.319 s）在各个临床亚组中均持续预测生存，并且在协变量调整后仍然显著，而低ICA-2ch病例的事件发生率急剧增加。此外，纳入ICA-2ch提高了包含典型LBBB模式的多变量风险模型的预测价值。
植入前ICA提示了CRT植入后长期生存和不良结局的定量预后阈值。
