采用适应性心脏再同步治疗算法进行程控的患者中无反应者的电失同步映射及优化

Electrical dyssynchrony mapping and optimization of nonresponders in patients programmed with the adaptive cardiac resynchronization therapy algorithm.

作者信息

Bank Alan J, Burns Kevin V, Brown Christopher D, Walser-Kuntz Evan, Czeck Madeline A, Hauser Robert G, Sengupta Jay D

机构信息

Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Cardiology Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.

Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.

出版信息

Heart Rhythm. 2025 Jul;22(7):1746-1755. doi: 10.1016/j.hrthm.2024.12.012. Epub 2024 Dec 13.

DOI:10.1016/j.hrthm.2024.12.012

PMID:39675652

Abstract

BACKGROUND

The adaptive cardiac resynchronization therapy (CRT) (aCRT) algorithm provides an important clinical benefit. However, a significant number of patients are nonresponders.

OBJECTIVES

The goals of this study were to quantify electrical synchrony in patients programmed with aCRT and to assess the echocardiographic effects of optimization in CRT nonresponders and incomplete responders.

METHODS

We studied 125 patients programmed with aCRT and measured electrical synchrony at multiple device settings using novel electrical dyssynchrony mapping (EDM) technology. Electrical synchrony was quantified as cardiac resynchronization index (CRI), a measure that analyzes areas between multiple pairs of anterior and posterior electrograms and calculates synchrony normalized to native rhythm.

RESULTS

CRI improved from baseline aCRT settings to optimal settings on the basis of EDM (56%±29% vs 92%±12%; P<.001). Patients programmed with left ventricle (LV)-only aCRT (group 1, n=68 [54%]) had a higher CRI (62%±25% vs 48%±31%; P=.014) than did patients programmed with biventricular aCRT (group 2, n=57 [46%]). In group 1 and group 2, optimal CRI during sequential biventricular (92%±13% and 93%±9%, respectively) and LV-only (92%±6% and 91%±7%, respectively) pacing was significantly (P<.001) higher than CRI at baseline aCRT setting. In a subset of 53 nonresponders optimized using EDM, there were significant improvements in CRI (37%±25%; P<.0001), LV ejection fraction (6.2%±6.6%; P<.0001), end-diastolic volume (9.5±28.2 mL; P=.015), end-systolic volume (13.4±24.9 mL; P<.001), and transverse (1.5%±4.4%; P=.014), longitudinal (1.0%±2.5%; P=.003), and circumferential (2.6%±8.5%; P=.047) strain.

CONCLUSION

Electrical synchrony improves 56% with CRT using aCRT programming and 92% with EDM optimization. Optimization of aCRT-programmed nonresponders results in significant improvements in LV size and systolic function, offering the possibility of converting CRT nonresponders into responders.

摘要

背景

适应性心脏再同步治疗（CRT）（aCRT）算法具有重要的临床益处。然而，相当数量的患者对此无反应。

目的

本研究的目的是量化接受aCRT治疗患者的电同步性，并评估CRT无反应者和反应不完全者优化后的超声心动图效果。

方法

我们研究了125例接受aCRT治疗的患者，并使用新型电失同步映射（EDM）技术在多种设备设置下测量电同步性。电同步性被量化为心脏再同步指数（CRI），该指标分析多对前后心电图之间的区域，并计算相对于自身节律归一化的同步性。

结果

基于EDM，CRI从基线aCRT设置改善到最佳设置（56%±29%对92%±12%；P<.001）。仅采用左心室（LV）aCRT治疗的患者（第1组，n = 68 [54%]）的CRI（62%±25%对48%±31%；P = 0.014）高于采用双心室aCRT治疗的患者（第2组，n = 57 [46%]）。在第1组和第2组中，顺序双心室起搏（分别为92%±13%和93%±9%）和仅LV起搏（分别为92%±6%和91%±7%）期间的最佳CRI显著高于基线aCRT设置时的CRI（P<.001）。在使用EDM优化的53例无反应者亚组中，CRI（37%±25%；P<.0001）、LV射血分数（6.2%±6.6%；P<.0001）、舒张末期容积（9.5±28.2 mL；P = 0.015）、收缩末期容积（13.4±24.9 mL；P<.001）以及横向应变（1.5%±4.4%；P = 0.014）、纵向应变（1.0%±2.5%；P = 0.003）和圆周应变（2.6%±8.5%；P = 0.047）均有显著改善。