Effects of Cardiac Resynchronization Therapy on Cardiac Remodeling and Contractile Function: Results From Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE).
Effects of Cardiac Resynchronization Therapy on Cardiac Remodeling and Contractile Function: Results From Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE).
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DOI：
10.1161/jaha.115.002054
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发表时间：
2015-09-11
影响因子：
5.4
通讯作者：
Ky B
中科院分区：
文献类型：
--
作者：
St John Sutton M;Cerkvenik J;Borlaug BA;Daubert C;Gold MR;Ghio S;Chirinos JA;Linde C;Ky B
心力衰竭患者心脏起搏治疗可改善射血分数。我们试图确定这些效应是否是由收缩力、后负荷或容积的变化介导的。在收缩期左心室功能障碍再同步逆转重塑（REVERSE）研究中，我们对610名患有纽约心脏协会I/II级心力衰竭的患者在心脏再同步治疗之前和之后进行了详细的定量超声心动图评估。我们推导出收缩力的测量值（收缩末期压力-容积关系的斜率[收缩末期弹性]和容积截距、每搏功和前负荷可复搏功）、动脉负荷和心室-动脉耦合的测量值以及心腔大小的测量值（容积截距、收缩末期和舒张末期容积）。在6个月和12个月时，心脏起搏治疗与容积截距、收缩末期和舒张末期容积的减少相关（P<0.01）。对收缩末期弹性、每搏功、前负荷可恢复的每搏功或心室-动脉耦合没有一致的影响。在主动心脏起搏治疗人群中，动脉负荷的基线测量值与临床综合评分相关（比值比1.30，95% CI 1.04 - 1.63，P=0.02）。容积截距与死亡率相关（风险比1.90，95% CI 1.01 - 3.59，P=0.047），与死亡率或心力衰竭住院治疗的联合终点相关性更小（风险比1.48，95% CI 0.8 - 2.25，P=0.06）。相反，收缩末期弹性、每搏功、前负荷可复搏功和心室-动脉耦联与任何结局无关。在NYHA I/II级心力衰竭患者中，心脏起搏治疗可使左心室收缩末期和舒张末期容积以及容积截距发生有利变化。容积截距可能有助于了解心力衰竭的预后。网址：https://www.clinicaltrials.gov/。唯一标识符：NCT 00271154。
Cardiac resynchronization therapy results in improved ejection fraction in patients with heart failure. We sought to determine whether these effects were mediated by changes in contractility, afterload, or volumes. In 610 patients with New York Heart Association class I/II heart failure from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study, we performed detailed quantitative echocardiography assessment prior to and following cardiac resynchronization therapy. We derived measures of contractility (the slope [end-systolic elastance] and the volume intercept of the end-systolic pressure–volume relationship, stroke work, and preload recruitable stroke work), measures of arterial load and ventricular–arterial coupling, and measures of chamber size (volume intercept, end-systolic and end-diastolic volumes). At 6 and 12 months, cardiac resynchronization therapy was associated with a reduction in the volume intercept and end-systolic and end-diastolic volumes (P<0.01). There were no consistent effects on end-systolic elastance, stroke work, preload recruitable stroke work, or ventricular–arterial coupling. In the active cardiac resynchronization therapy population, baseline measures of arterial load were associated with the clinical composite score (odds ratio 1.30, 95% CI 1.04 to 1.63, P=0.02). The volume intercept was associated with mortality (hazard ratio 1.90, 95% CI 1.01 to 3.59, P=0.047) and more modestly with the combined end point of mortality or heart failure hospitalization (hazard ratio 1.48, 95% CI 0.8 to 2.25, P=0.06). In contrast, end-systolic elastance, stroke work, preload recruitable stroke work, and ventricular–arterial coupling were not associated with any outcomes. In patients with NYHA Class I/II heart failure, cardiac resynchronization therapy exerts favorable changes in left ventricular end-systolic and end-diastolic volumes and the volume intercept. The volume intercept may be useful to gain insight into prognosis in heart failure. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00271154.