Tan Chaodi, Li Zongjian, Zheng Yuping, Chen Ying, Huang Boshui, Zheng Shaoxin, Zhou Shuxian
Division of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China.
Quant Imaging Med Surg. 2024 Aug 1;14(8):5748-5761. doi: 10.21037/qims-24-393. Epub 2024 Jul 22.
Previous studies have indicated that despite adhering to current patient selection guidelines, there remains a 30% to 40% subset of patients who do not experience improvement in heart failure (HF) after receiving cardiac resynchronization therapy (CRT). We aim to utilize echocardiographic myocardial work parameters to serve as predictors of responsiveness to CRT in patients with heart failure and reduced ejection fraction (HFrEF).
We prospectively recruited patients who underwent CRT at Sun Yat-sen Memorial Hospital from June 2019 to September 2022. Comprehensive preoperative information, clinical laboratory data, conventional echocardiographic parameters and myocardial work were collected for all participants, as well as follow-up data 6 months after CRT.
Twenty-five patients (67.6%) showed response to CRT treatment, while twelve patients (32.4%) had no response. Compared with the non-response group, the response group had larger region constructive work [RCW: the sum of constructive work (CW) in the 9 segments of the basal, mid, and apical segments of the anterior, lateral, and posterior walls], region wasted work [RWW: the sum of wasted work (WW) in the 6 segments of the basal and mid segments of the anterior septum, posterior septum and anterior walls], and the combination of RCW and RWW (RCW + RWW) in baseline (RCW: 9,695.68±2,955.40 . 5,219.50±2,207.68 mmHg%, P<0.001; RWW: 3,612.08±1,723.80 . 1,674.33±995.23 mmHg%, P=0.001; RCW + RWW: 13,307.76±3,857.71 . 6,893.83±2,592.83 mmHg%, P<0.001). Furthermore, global constructive work (GCW), global wasted work (GWW), GCW + GWW, RCW, RWW, and RCW + RWW had areas under the receiver operating characteristic curve (AUCs) of 0.870, 0.770, 0.860, 0.890, 0.870, and 0.910, respectively, for predicting CRT responsiveness.
The global and regional myocardial work parameters are associated with CRT response in CRT candidates. Particularly regional myocardial work parameters appear to be promising parameters to improve selection for CRT of patients with HFrEF.
既往研究表明，尽管遵循当前的患者选择指南，但仍有30%至40%的患者在接受心脏再同步治疗（CRT）后心力衰竭（HF）症状未得到改善。我们旨在利用超声心动图心肌做功参数作为射血分数降低的心力衰竭（HFrEF）患者对CRT反应性的预测指标。
我们前瞻性招募了2019年6月至2022年9月在中山大学孙逸仙纪念医院接受CRT治疗的患者。收集了所有参与者的术前综合信息、临床实验室数据、传统超声心动图参数和心肌做功情况，以及CRT治疗后6个月的随访数据。
25例患者（67.6%）对CRT治疗有反应，12例患者（32.4%）无反应。与无反应组相比，反应组在基线时的节段性建设性做功[RCW：前壁、侧壁和后壁基底段、中间段和心尖段9个节段的建设性做功（CW）总和]、节段性废用做功[RWW：前间隔、后间隔和前壁基底段和中间段6个节段的废用做功（WW）总和]以及RCW与RWW之和（RCW + RWW）更高（RCW：9,695.68±2,955.40. 5,219.50±2,207.68 mmHg%，P<0.001；RWW：3,612.08±1,723.80. 1,674.33±995.23 mmHg%，P = 0.001；RCW + RWW：13,307.76±3,857.71. 6,893.83±2,592.83 mmHg%，P<0.001）。此外，整体建设性做功（GCW）、整体废用做功（GWW）、GCW + GWW、RCW、RWW和RCW + RWW预测CRT反应性的受试者工作特征曲线下面积（AUC）分别为0.870、0.770、0.860、0.890、0.870和0.910。
整体和节段性心肌做功参数与CRT候选患者的CRT反应相关。特别是节段性心肌做功参数似乎是改善HFrEF患者CRT选择的有前景的参数。
