Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy.
Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy.
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DOI：
10.1016/j.amjcard.2016.05.017
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发表时间：
2016-08-01
期刊：
影响因子：
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通讯作者：
Tereshchenko LG
中科院分区：
文献类型：
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作者：
Jacobsson J;Borgquist R;Reitan C;Ghafoori E;Chatterjee NA;Kabir M;Platonov PG;Carlson J;Singh JP;Tereshchenko LG
心脏复律治疗（CRT）降低了选定的心力衰竭（HF）患者的死亡率和发病率，但高达三分之一的患者无应答。最近研究表明，绝对Q积分之和（SAI Q积分）与CRT的机械反应有关。然而，尚不清楚SAI QST是否与CRT患者的全因死亡率和HF住院相关。研究人群包括496例接受CRT的患者（平均年龄69±10岁，84%为男性，65%为左束分支传导阻滞（LBBB），左心室射血分数23± 6%，63%为缺血性心肌病）。将植入前数字12导联ECG转换为正交XYZ ECG。SAI Qmax测量为XYZ导联Qmax曲线下面积的算术和，并基于中值（302 mV *ms）进行二分。全因死亡率作为主要终点。2年全因死亡率、心脏移植和HF住院的复合终点是次要终点。针对CRT反应的已知预测因素调整了考克斯回归模型。植入前平均SAI QOL较低的患者在多变量调整后主要（HR 1.8; 95%CI 1.01-3.2）和次要（HR 1.6，95%CI 1.1-2.2）终点的风险均增加。在LBBB患者亚组（HR 2.1 [95%CI 1.5-3.0]）和非LBBB患者亚组（HR 1.7，[95%CI 1.0-2.6]）中，SAI QdR与次要结局相关。在接受CRT的患者中，植入前SAI Qmax <302 mV *ms与全因死亡率和HF住院风险增加相关。在另一个前瞻性队列中验证后，SAI QSII可能有助于改进CRT接受者的选择。
Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected heart failure (HF) patients, but up to one-third of patients are non-responders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in CRT patients. The study population included 496 patients undergoing CRT (mean age 69±10 years, 84% male, 65% left bundle branch block (LBBB), left ventricular ejection fraction 23±6%, 63% ischemic cardiomyopathy). Pre-implant digital 12-lead ECG was transformed into orthogonal XYZ ECG. SAI QRST was measured as an arithmetic sum of areas under the QRST curve on XYZ leads, and was dichotomized based on the median value (302mV*ms). All-cause mortality served as the primary endpoint. A composite of 2-year all-cause mortality, heart transplant, and HF hospitalization was a secondary endpoint. Cox regression models were adjusted for known predictors of CRT response. Patients with pre-implant low mean SAI QRST had an increased risk of both the primary (HR 1.8; 95%CI 1.01–3.2) and secondary (HR 1.6, 95% CI 1.1–2.2) endpoints following multivariable adjustment. SAI QRST was associated with secondary outcome in subgroups of patients with LBBB (HR 2.1 [95%CI 1.5-3.0]) and with non-LBBB (HR 1.7, [95%CI 1.0-2.6]). In patients undergoing CRT, pre-implant SAI QRST<302mV*ms was associated with an increased risk of all-cause mortality and HF hospitalization. After validation in another prospective cohort, SAI QRST may help to refine selection of CRT recipients.