Relative Merits of Left Ventricular Dyssynchrony, Left Ventricular Lead Position, and Myocardial Scar to Predict Long-Term Survival of Ischemic Heart Failure Patients Undergoing Cardiac Resynchronization Therapy
Relative Merits of Left Ventricular Dyssynchrony, Left Ventricular Lead Position, and Myocardial Scar to Predict Long-Term Survival of Ischemic Heart Failure Patients Undergoing Cardiac Resynchronization Therapy
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DOI：
10.1161/circulationaha.110.945345
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发表时间：
2011-01-04
期刊：
影响因子：
37.8
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Delgado, Victoria;van Bommel, Rutger J.;Bax, Jeroen J.
背景：心脏再同步化治疗后，左心室(LV)不同步、LV导联位置和心肌瘢痕预测远期疗效的相对优点尚不清楚，本研究对其进行了评估。方法和结果：对397例缺血性心力衰竭患者进行了二维斑点追踪成像，综合评估LV径向不同步，识别最近机械激活的节段，并检测LV导联所在节段的心肌瘢痕。对于LV不同步，使用130毫秒的截止值。具有50%透壁性的节段，在对比度增强磁共振成像的亚组中进行验证)。LV导联位置由胸部X线片确定。长期随访包括全因死亡率和因心力衰竭住院。平均基线LV径向不同步为133+/-98毫秒。271例患者(68%)将LV导联放置在最后一个激活节段(一致的LV导联位置)，靶段的径向应变峰值平均值为18.9+/-12.6%。基线时较大的LV径向不同步是较好的长期生存的独立预测因素(风险比，0.995；P=0.001)，而不协调的LV导联位置(风险比，2.086；P=0.001)和靶向LV导联的心肌疤痕(风险比，2.913；P
Background-The relative merits of left ventricular (LV) dyssynchrony, LV lead position, and myocardial scar to predict long-term outcome after cardiac resynchronization therapy remain unknown and were evaluated in the present study.Methods and Results-In 397 ischemic heart failure patients, 2-dimensional speckle tracking imaging was performed, with comprehensive assessment of LV radial dyssynchrony, identification of the segment with latest mechanical activation, and detection of myocardial scar in the segment where the LV lead was positioned. For LV dyssynchrony, a cutoff value of 130 milliseconds was used. Segments with 50% transmurality, validated in a subgroup with contrast-enhanced magnetic resonance imaging). The LV lead position was derived from chest x-ray. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Mean baseline LV radial dyssynchrony was 133+/-98 milliseconds. In 271 patients (68%), the LV lead was placed at the latest activated segment (concordant LV lead position), and the mean value of peak radial strain at the targeted segment was 18.9+/-12.6%. Larger LV radial dyssynchrony at baseline was an independent predictor of superior long-term survival (hazard ratio, 0.995; P=0.001), whereas a discordant LV lead position (hazard ratio, 2.086; P=0.001) and myocardial scar in the segment targeted by the LV lead (hazard ratio, 2.913; P