Sedova Ksenia, Azarov Jan E, Van Dam Peter M, Necasova Lucie, Kukla Jan, Sramko Marek, Kryze Lukas, Kautzner Josef
Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic.
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
J Cardiovasc Electrophysiol. 2025 Feb;36(2):338-346. doi: 10.1111/jce.16525. Epub 2024 Dec 2.
A variable proportion of non-responders to cardiac resynchronization therapy (CRT) warrants the search for new approaches to optimize the position of the left ventricular (LV) lead and the CRT device programming. CineECG is a novel ECG modality proposed for the spatial visualization and quantification of myocardial depolarization and repolarization sequences.
The present study aimed to evaluate CineECG-derived parameters in different pacing modes and to test their associations with acute hemodynamic responses in CRT patients.
CineECG was used to construct the average electrical path within the cardiac anatomy from the 12-lead ECG. CineECG and LV dP/dt max were tested in 15 patients with nonischemic dilated cardiomyopathy and left bundle branch block (QRS: 170 ± 17 ms; LVEF: 26 ± 5.5%) under pacing protocols with different LV lead localizations. The CineECG-derived path directions were computed for the QRS and ST-T intervals for the anteroposterior (X), interventricular (Y), and apicobasal (Z) axes. In a multivariate linear regression analysis with adjustment for the pacing protocol type, the ST-T path direction Y was independently associated with the increase in dP/dt max during CRT, [regression coefficient 639.4 (95% confidence interval: 187.9-1090.9), p = 0.006]. In ROC curve analysis, the ST-T path direction Y was associated with the achievement of a 10% increase in dP/dt max (AUC: 0.779, p = 0.002) with the optimal cut-off > 0.084 (left-to-right direction) with sensitivity 0.67 and specificity 0.92.
The acute hemodynamic response in CRT patients was associated with specific CineECG repolarization sequence parameters, warranting their further testing as potential predictors of clinical outcomes.
心脏再同步治疗（CRT）存在一定比例的无反应者，这就需要寻找新的方法来优化左心室（LV）导线的位置和CRT设备编程。动态心电图（CineECG）是一种新型心电图模式，旨在对心肌去极化和复极化序列进行空间可视化和量化。
本研究旨在评估不同起搏模式下CineECG衍生参数，并测试它们与CRT患者急性血流动力学反应的相关性。
利用CineECG从12导联心电图构建心脏解剖结构内的平均电通路。在不同LV导线定位的起搏方案下，对15例非缺血性扩张型心肌病和左束支传导阻滞患者（QRS：170±17毫秒；左心室射血分数：26±5.5%）进行CineECG和LV dP/dt max测试。计算QRS和ST-T间期在前后（X）、室间（Y）和心尖基底（Z）轴上CineECG衍生的通路方向。在对起搏方案类型进行调整的多变量线性回归分析中，ST-T通路方向Y与CRT期间dP/dt max的增加独立相关，[回归系数639.4（95%置信区间：187.9-1090.9），p = 0.006]。在ROC曲线分析中，ST-T通路方向Y与dP/dt max增加10%相关（曲线下面积：0.779，p = 0.002），最佳截断值> 0.084（从左到右方向），敏感性为0.67，特异性为0.92。
CRT患者急性血流动力学反应与特定的CineECG复极化序列参数相关，有必要进一步测试这些参数作为临床结果的潜在预测指标。
