Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Noninvasive Electrocardiol. 2024 Sep;29(5):e70004. doi: 10.1111/anec.70004.
The fibrosis-5 (FIB-5) index is a noninvasive marker for assessing the progression of liver fibrosis and predictor in patients with heart failure (HF). This study investigated the association between the FIB-5 index and response to cardiac resynchronization therapy (CRT) and evaluated its predictive value for prognosis.
In total, 203 patients who underwent CRT/CRT-defibrillator (CRT-D) implantation were retrospectively included. The FIB-5 index was calculated using blood samples obtained before and after CRT/CRT-D. Response to CRT was defined as a relative reduction in left ventricular end-systolic volume of ≥15% 6 months after CRT/CRT-D. We compared the prognosis after CRT/CRT-D between the groups according to the FIB-5 index.
One hundred and twenty-three patients (61%) responded to CRT. The responder group demonstrated a significantly higher FIB-5 index than the nonresponder group (-2.76 ± 3.85 vs. -4.67 ± 3.29, p < 0.001). Receiver-operating characteristic analysis demonstrated that the area under the curve of the FIB-5 index was 0.660 with a cutoff value of -4.00 for responders. In multivariate analysis, FIB-5 index ≥ -4.00 was an independent predictor for CRT response (odds ratio: 3.665, p = 0.003), in addition to QRS duration ≥ 150 ms and echocardiographic dysynchrony. The FIB-5 index increased significantly after 6 months in the responder group but not in the nonresponder group. The FIB-5 index ≥ -4.00 group showed a significantly better prognosis for cardiac death, HF hospitalization, and composite endpoint than the FIB-5 index < -4.00 group.
The FIB-5 index in addition to classical predictors may be a useful marker for predicting response to CRT.
纤维化-5 （FIB-5）指数是一种非侵入性的肝纤维化进展标志物和心力衰竭（HF）患者的预测因子。本研究探讨了 FIB-5 指数与心脏再同步治疗（CRT）反应之间的关系，并评估了其对预后的预测价值。
共纳入 203 例接受 CRT/CRT-除颤器（CRT-D）植入的患者进行回顾性分析。使用 CRT/CRT-D 前后的血液样本计算 FIB-5 指数。CRT 反应定义为 CRT/CRT-D 后 6 个月左心室收缩末期容积相对减少≥15%。根据 FIB-5 指数比较 CRT/CRT-D 后两组的预后。
123 例（61%）患者对 CRT 有反应。反应组的 FIB-5 指数明显高于无反应组（-2.76±3.85 与-4.67±3.29，p<0.001）。ROC 分析显示，FIB-5 指数的曲线下面积为 0.660，截断值为-4.00 时对反应者有意义。多变量分析显示，FIB-5 指数≥-4.00 是 CRT 反应的独立预测因子（优势比：3.665，p=0.003），此外还有 QRS 持续时间≥150 ms 和超声心动图不同步。反应组的 FIB-5 指数在 6 个月后显著升高，但无反应组无明显变化。FIB-5 指数≥-4.00 组的心脏死亡、HF 住院和复合终点的预后明显优于 FIB-5 指数<-4.00 组。
除了经典预测因子外，FIB-5 指数可能是预测 CRT 反应的有用标志物。
