基于施特劳斯标准的左束支传导阻滞型心力衰竭的心脏再同步治疗
Cardiac resynchronization therapy in heart failure based on Strauss criteria for left bundle branch block.
作者信息
Saplaouras Athanasios, Vlachos Konstantinos, Mililis Panagiotis, Batsouli Athena, Bazoukis George, Xydonas Sotirios, Niarchou Panagioula, Frontera Antonio, Dragasis Stylianos, Kariki Ourania, Patsiotis Ilias G, Gkouziouta Aggeliki, Stachteas Panagiotis, Korantzopoulos Panagiotis, Tzeis Stylianos, Fragakis Nikolaos, Efremidis Michael, Letsas Konstantinos P
机构信息
Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
出版信息
ESC Heart Fail. 2025 Feb;12(1):174-184. doi: 10.1002/ehf2.15028. Epub 2024 Sep 20.
AIMS
The left bundle branch block (LBBB) is a strong predictor of response to cardiac resynchronization therapy (CRT). However, a significant number of patients do not respond to the treatment. The study sought to evaluate the impact of the stricter Strauss criteria for left bundle branch block (St-LBBB) on CRT response, hospitalizations, ventricular arrhythmia (VA) events and mortality.
METHODS
This study is a retrospective analysis of prospectively collected data on heart failure (HF) patients with LBBB admitted for CRT implantation. Patients were divided into two groups according to the fulfilment or not of St-LBBB criteria.
RESULTS
The study included 82 patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy [46 (56%) with St-LBBB and 36 (44%) with non-St-LBBB]. Patients with St-LBBB showed higher CRT response rates compared with those with non-St-LBBB (P < 0.01), while the group with NICM exhibited the greatest benefit (P < 0.01). St-LBBB CRT responders displayed significantly lower rates of HF hospitalization (P < 0.0001) compared with the non-St-LBBB group. According to Kaplan-Meier time curves, this was primarily evident in patients with NICM (P < 0.0001). CRT responders displayed significantly fewer VA events (P < 0.001) and lower mortality rates (P < 0.0001) than non-responders. Kaplan-Meier estimates demonstrated a significantly lower incidence of VAs in NICM patients with St-LBBB (P = 0.049) compared with ICM patients with St-LBBB (P = 0.25). Lower mortality rates were observed in CRT responders than non-responders (P < 0.0001), with the group of NICM with St-LBBB criteria exhibiting the greatest benefit (P = 0.0238).
CONCLUSIONS
Patients with NICM and St-LBBB present the greatest benefit concerning CRT response, HF hospitalizations, VA events and mortality. Although St-LBBB criteria seem to improve patient selection for CRT, more data are needed to elucidate the role of St-LBBB criteria in this setting.
目的
左束支传导阻滞（LBBB）是心脏再同步治疗（CRT）反应的有力预测指标。然而，相当一部分患者对该治疗无反应。本研究旨在评估更严格的左束支传导阻滞施特劳斯标准（St-LBBB）对CRT反应、住院率、室性心律失常（VA）事件及死亡率的影响。
方法
本研究是对前瞻性收集的因CRT植入而入院的LBBB心力衰竭（HF）患者数据的回顾性分析。根据是否符合St-LBBB标准将患者分为两组。
结果
该研究纳入了82例缺血性心肌病（ICM）和非缺血性心肌病（NICM）患者[46例（56%）符合St-LBBB标准，36例（44%）不符合St-LBBB标准]。与不符合St-LBBB标准的患者相比，符合St-LBBB标准的患者CRT反应率更高（P<0.01），而NICM组获益最大（P<0.01）。与不符合St-LBBB标准的组相比，符合St-LBBB标准的CRT反应者HF住院率显著更低（P<0.0001）。根据Kaplan-Meier时间曲线，这在NICM患者中最为明显（P<0.0001）。与无反应者相比，CRT反应者的VA事件显著更少（P<0.001），死亡率更低（P<0.0001）。Kaplan-Meier估计显示，与符合St-LBBB标准的ICM患者相比（P=0.25），符合St-LBBB标准 的NICM患者VA发生率显著更低（P=0.049）。CRT反应者的死亡率低于无反应者（P<0.0001），符合St-LBBB标准的NICM组获益最大（P=0.0238）。
结论
NICM且符合St-LBBB标准的患者在CRT反应、HF住院、VA事件及死亡率方面获益最大。尽管St-LBBB标准似乎能改善CRT患者的选择，但仍需要更多数据来阐明St-LBBB标准在此情况下的作用。
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