Role of myocardial constructive work in the identification of responders to CRT
Role of myocardial constructive work in the identification of responders to CRT
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DOI：
10.1093/ehjci/jex191
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发表时间：
2018-09-01
影响因子：
6.2
通讯作者：
Donal, Erwan
中科院分区：
文献类型：
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作者：
Galli, Elena;Leclercq, Christophe;Donal, Erwan
目的 心脏再同步治疗 (CRT) 在心力衰竭 (HF) 和宽 QRS 波群患者的治疗中发挥着关键作用。然而，该治疗受到许多无反应者的困扰。本研究的目的是评估压力应变环 (PSL) 估计的心肌做功在理解 CRT 相关生理机制和预测 CRT 反应中的作用。 方法和结果 本研究回顾性纳入了 97 例根据当前建议接受 CRT 植入的有症状心力衰竭患者（射血分数：27 +/- 6%，QRS 时限 164 +/- 18 毫秒）。在 CRT 之前和 6 个月随访 (FU) 时进行标准 2D 和斑点追踪超声心动图检查。 PSL 分析允许计算全局和区域心肌建设性功 (CW) 和无用功 (WW)。 FU 时左心室 (LV) 收缩末期容积减少 > 15% 定义为 CRT 阳性反应 (CRT-PR)。在 FU 时，63 名 (65%) 患者对 CRT 有反应。 CRT 应答者的总体 CW (CWtot) 显着增加。在多变量分析中，CWtot > 1057 mmHg%（OR 14.69，P=0.005）和间隔闪光（OR 8.05，P=0.004）是 CRT-PR 的唯一显着预测因子。 CWtot 与 CRT 诱导的心肌重塑相关（r=-0.55，P
Aims Cardiac resynchronization therapy (CRT) plays a pivotal role in the management of patients with heart failure (HF) and wide QRS complex. However, the treatment is plagued by numerous non-responders. Aim of the study is to evaluate the role myocardial work estimated by pressure-strain loops (PSLs) in the comprehension of physiological mechanisms associated with CRT and in the prediction of CRT response.Methods and results Ninety-seven patients with symptomatic HF (ejection fraction: 27 +/- 6%, QRS duration 164 +/- 18ms) undergoing CRT implantation according to current recommendations were retrospectively included in the study. Standard 2D and speckle tracking echocardiography were performed before CRT and at the 6-month follow-up (FU). PSL analysis allowed the calculation of global and regional myocardial constructive work (CW) and wasted work (WW). A > 15% reduction in left ventricular (LV) end-systolic volume at FU defined CRT-positive response (CRT-PR). At FU, 63 (65%) patients responded to CRT. Global CW (CWtot) was significantly increased in CRT-responders. At multivariate analysis, CWtot > 1057 mmHg% (OR 14.69, P=0.005) and septal flash (OR 8.05, P=0.004) were the only significant predictors of CRT-PR. CWtot was associated with the entity of CRT-induced myocardial remodelling in both ischaemic (r=-0.55, P