A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy
A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy
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DOI：
10.1016/j.hrthm.2014.06.005
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发表时间：
2014-10-01
期刊：
影响因子：
5.5
通讯作者：
Rinaldi, Christopher Aldo
中科院分区：
文献类型：
--
作者：
Jackson, Tom;Sohal, Manav;Rinaldi, Christopher Aldo
根据病理生理学原理定义严格左束支分支传导阻滞（LBBB）的新标准可预测对心脏起搏治疗（CRT）的反应。在经典LBBB患者中已经确定了异质性激活和收缩模式。心脏磁共振（CMR）成像已经证明，U形（II型）收缩预测CRT后的逆转重构。本研究的目的是调查严格LBBB患者的收缩模式，并测试II型收缩模式是否能更好地预测CRT反应和超反应。（男性QRS持续时间> 140 ms，女性>130 ms，在> 2个连续导联中出现中间QRS切迹或模糊）在CRT前接受电影CMR成像，并使用endoMRI轮廓跟踪软件分析其收缩模式。患者进行了评估，逆重构6个月postimplantation.Results十九例（51%）有一个II型收缩模式。队列中共有25例患者（68%）发生逆转重塑。Ⅱ型收缩组19例（100%）逆转，Ⅰ型收缩组6例（33%）逆转（P
BACKGROUND New criteria to define strict left bundle branch block (LBBB) on the basis of pathophysiological principles predict response to cardiac resynchronization therapy (CRT). Heterogeneous activation and contraction patterns have been identified in patients with classical LBBB. Cardiac magnetic resonance (CMR) imaging has demonstrated that a U-shaped (type II) contraction predicts reverse remodeling post-CRT. A homogeneous spread of (type I) contraction is less predictive.OBJECTIVES The purpose of this study was to investigate contraction patterns among patients with strict LBBB and to test whether a type II contraction pattern better predicts CRT response and super-response.METHODS Thirty-seven patients with strict LBBB (QRS duration > 140 ms for men and >130 ms for women with mid-QRS notching or slurring in > 2 contiguous leads) underwent cine CMR imaging pre-CRT with an analysis of their contraction patterns by using endocardial contour tracking software. Patients were evaluated for reverse remodeling 6 months postimplantation.RESULTS Nineteen patients (51%) had a type II contraction pattern. A total of 25 patients (68%) of the cohort reverse remodeled. In the type II contraction group, all 19 patients (100%) reverse remodeled as compared with 6 patients (33%) in the type I contraction group (P