Boxhammer Elke, Zauner Sophie, Kraus Johannes, Dinges Christian, Schernthaner Christiana, Danmayr Franz, Kolbitsch Tobias, Granitz Christina, Motloch Lukas J, Hammerer Matthias, Lichtenauer Michael, Hoppe Uta C, Strohmer Bernhard
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria.
Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria.
J Clin Med. 2024 Aug 21;13(16):4938. doi: 10.3390/jcm13164938.
Heart failure (HF) remains a challenging healthcare issue necessitating innovative therapies like cardiac resynchronization-defibrillation therapy (CRT-D). However, the definition of a CRT-D response lacks uniformity, impeding effective clinical evaluation. This study explores diverse CRT-D responder definitions encompassing functional, echocardiographic and laboratory criteria. A single-center study involving 132 CRT-D patients scrutinized responder criteria including NYHA stage, LVEF increase and proBNP decrease. Statistical analyses such as Kaplan-Meier curves and Cox hazard regression were employed to evaluate responder characteristics and survival outcomes. Responder rates varied across criteria, revealing nuanced patient profiles. CRT-D responders defined by NYHA decrease, LVEF increase or proBNP decrease exhibit improved survival rates after 2 and 3 years ( < 0.050). Young age, absence of recent myocardial infarction and normal right ventricular echocardiographic parameters emerge as predictors for positive response. In part, drug-based HF therapy correlates with increased responder rates. Cox regression identified LVEF ≥ 5% and proBNP decrease ≥ 25% as independent predictors of extended survival. CRT-D responder definitions exhibit considerable variability, emphasizing the need for a nuanced patient-centered approach. Factors like right ventricular function, drug therapy, atrial fibrillation and renal function influence responses. This study enriches our understanding of CRT-D response and contributes to the foundation for personalized HF management.
心力衰竭（HF）仍然是一个具有挑战性的医疗保健问题，需要诸如心脏再同步除颤治疗（CRT-D）等创新疗法。然而，CRT-D反应的定义缺乏一致性，阻碍了有效的临床评估。本研究探索了包括功能、超声心动图和实验室标准在内的多种CRT-D反应者定义。一项涉及132例CRT-D患者的单中心研究仔细审查了反应者标准，包括纽约心脏协会（NYHA）分级、左心室射血分数（LVEF）增加和脑钠肽前体（proBNP）降低。采用Kaplan-Meier曲线和Cox风险回归等统计分析来评估反应者特征和生存结果。不同标准下的反应者率各不相同，揭示了细微的患者特征。由NYHA分级降低、LVEF增加或proBNP降低定义的CRT-D反应者在2年和3年后生存率有所提高（<0.050）。年轻、近期无心肌梗死以及右心室超声心动图参数正常是阳性反应的预测因素。部分基于药物的HF治疗与反应者率增加相关。Cox回归确定LVEF≥5%和proBNP降低≥25%是延长生存的独立预测因素。CRT-D反应者定义存在相当大的变异性，强调需要一种以患者为中心的细致入微的方法。右心室功能、药物治疗、心房颤动和肾功能等因素会影响反应。本研究丰富了我们对CRT-D反应的理解，并为个性化HF管理奠定了基础。
