Results of the predictors of response to CRT (PROSPECT) trial
Results of the predictors of response to CRT (PROSPECT) trial
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DOI：
10.1161/circulationaha.107.743120
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发表时间：
2008-05-20
期刊：
影响因子：
37.8
通讯作者：
Murillo, Jaime
中科院分区：
文献类型：
--
作者：
Chung, Eugene S.;Leon, Angel R.;Murillo, Jaime
背景-来自单中心研究的数据表明，机械不同步的超声心动图参数可能会改善心脏再同步治疗(CRT)患者的选择。在一项前瞻性的多中心研究中，CRT反应的预测因子(PROCESS)研究测试了这些参数预测CRT反应的性能。方法和结果--欧洲、香港和美国的53个中心招募了498名具有标准CRT指征的患者(纽约心脏协会心力衰竭III级或IV级，左心室射血分数=130毫秒，稳定的医疗方案)。12个超声心动图参数的不同步，基于传统的和基于组织多普勒的方法，在采集方法的现场训练和盲法核心实验室分析后被评估。CRT阳性反应的指标是临床综合评分的改善和6个月后左室收缩末期容量减少15%。在有配对数据的426名患者中，69%的患者临床综合评分得到改善，而在286名患者中，56%的患者左心室收缩末期容量下降了15%。12项超声心动图参数预测临床综合记分反应的能力差异很大，敏感性为6%~74%，特异性为35%~91%，预测左心室收缩末期容量反应的敏感性为9%~77%，特异性为31%~93%。对于所有参数，CRT临床或容量反应阳性的受试者操作特征曲线下的面积为
Background-Data from single-center studies suggest that echocardiographic parameters of mechanical dyssynchrony may improve patient selection for cardiac resynchronization therapy (CRT). In a prospective, multicenter setting, the Predictors of Response to CRT (PROSPECT) study tested the performance of these parameters to predict CRT response.Methods and Results-Fifty-three centers in Europe, Hong Kong, and the United States enrolled 498 patients with standard CRT indications (New York Heart Association class III or IV heart failure, left ventricular ejection fraction = 130 ms, stable medical regimen). Twelve echocardiographic parameters of dyssynchrony, based on both conventional and tissue Doppler-based methods, were evaluated after site training in acquisition methods and blinded core laboratory analysis. Indicators of positive CRT response were improved clinical composite score and >= 15% reduction in left ventricular end-systolic volume at 6 months. Clinical composite score was improved in 69% of 426 patients, whereas left ventricular end-systolic volume decreased >= 15% in 56% of 286 patients with paired data. The ability of the 12 echocardiographic parameters to predict clinical composite score response varied widely, with sensitivity ranging from 6% to 74% and specificity ranging from 35% to 91%; for predicting left ventricular end-systolic volume response, sensitivity ranged from 9% to 77% and specificity from 31% to 93%. For all the parameters, the area under the receiver-operating characteristics curve for positive clinical or volume response to CRT was