Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis
Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis
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DOI：
10.1093/eurheartj/ehp368
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发表时间：
2009-10-01
影响因子：
39.3
通讯作者：
Ghio, Stefano
中科院分区：
文献类型：
--
作者：
van Bommel, Rutger J.;Bax, Jeroen J.;Ghio, Stefano
目的心脏复律治疗（CRT）反应的预测因子（前景）是第一个大规模的多中心临床试验，评价了几种超声心动图测量机械不同步预测CRT反应的能力。由于对CRT的反应可以被定义为一个谱，并且可能受到许多因素的影响，因此本子分析旨在调查基线特征与CRT反应测量之间的关系。方法和结果根据CRT 6个月后左室收缩末期容积（LVESV）的相对减少，（LVESV降低>= 30%），应答者（LVESV降低15-29%），无应答者（LVESV降低0-14%），和阴性反应者此外，根据临床和/或超声心动图反应-，+/+反应者形成三个亚组（临床改善和LVESV降低>= 15%），+/-应答者（临床改善或LVESV降低>= 15%）和-/-应答者（无临床改善且LVESV未降低>= 15%），分析了这些亚组之间临床和超声心动图基线特征的差异，超应答者更常见于女性，患有非缺血性心力衰竭（HF），在基线时有更宽的QRS波群和更广泛的机械不同步，相反，阴性应答者更常见于纽约心脏协会IV级，并有室性心动过速（VT）病史，CRT后合并阳性应答者（+/+应答者）有更多的非缺血性病因，基线时更广泛的机械不同步，并且没有VT病史。结论前景数据的亚组分析显示，性别、HF病因、QRS时限、HF严重程度、VT病史、和基线机械不同步的存在影响临床和/或CRT后左心室逆转重构，尽管整合这些特征的信息将改善CRT患者的选择和咨询，但在改变CRT患者选择的现行指南之前，还需要进一步的随机对照试验。
Aims Predictors of Response to Cardiac Resynchronization Therapy (CRT) (PROSPECT) was the first large-scale, multicentre clinical trial that evaluated the ability of several echocardiographic measures of mechanical dyssynchrony to predict response to CRT. Since response to CRT may be defined as a spectrum and likely Influenced by many factors, this sub-analysis aimed to Investigate the relationship between baseline characteristics and measures of response to CRT.Methods and results A total of 286 patients were grouped according to relative reduction In left ventricular end-systolic volume (LVESV) after 6 months of CRT, super-responders (reduction In LVESV >= 30%), responders (reduction In LVESV 15-29%), non-responders (reduction In LVESV 0-14%), and negative responders (increase in LVESV), In addition, three subgroups were formed according to clinical and/or echocardiographic response-, +/+ responders (clinical Improvement and a reduction In LVESV >= 15%), +/- responders (clinical Improvement or a reduction In LVESV >= 15%), and -/- responders (no clinical Improvement and no reduction In LVESV >= 15%), Differences In clinical and echocardiographic baseline characteristics between these subgroups were analysed, Super-responders were more frequently females, had non-ischaemic heart failure (HF), and had a wider QRS complex and more extensive mechanical dyssynchrony at baseline, Conversely, negative responders were more frequently In New York Heart Association class IV and had a history of ventricular tachycardia (VT), Combined positive responders after CRT (+/+ responders) had more non-ischaemic aetiology, more extensive mechanical dyssynchrony at baseline, and no history of VT.Conclusion Sub-analysis of data from PROSPECT showed that gender, aetiology of HF, QRS duration, severity of HF, a history of VT, and the presence of baseline mechanical dyssynchrony influence clinical and/or LV reverse remodelling after CRT, Although Integration of Information about these characteristics would Improve patient selection and counselling for CRT, further randomized controlled trials are necessary prior to changing the current guidelines regarding patient selection for CRT.