The definition of left bundle branch block influences the response to cardiac resynchronization therapy
The definition of left bundle branch block influences the response to cardiac resynchronization therapy
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DOI：
10.1016/j.ijcard.2018.07.060
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发表时间：
2018-10-15
影响因子：
3.5
通讯作者：
Auricchio, Angelo
中科院分区：
文献类型：
--
作者：
Caputo, Maria Luce;van Stipdonk, Antonius;Auricchio, Angelo
背景：CRT已被证明在左束支分支传导阻滞形态（LBBB）患者中获益最大。然而，定义LBBB的ECG标准彼此显著不同。本研究的目的是评估不同的心电图标准对LBBB定义的影响，对接受心脏重建治疗（CRT）的患者的生存率，心力衰竭住院率和逆转重构。方法和结果：316例连续患者被纳入分析。根据AHA/ACC/HRS、ESC 2006、ESC 2009、ESC 2013和Strauss及其同事提出的分类，在接受CRT器械的患者的基线ECG中评估了6种不同的分类：QRS持续时间>= 150 ms和LBBB。在单变量分析中，ESC 2009和2013以及Strauss分类与心力衰竭（HF）和死亡率的累积概率降低显著相关（分别为HR 0.60，95% CI 0.42-0.86，HR 0.61，95% CI 0.43-0.87和HR 0.57，95% CI 0.40-0.80）。在多变量分析中，仅证实了ESC 2009和2013分类以及Strauss与联合终点的相关性。此外，全因死亡和HF住院的累积概率较高的患者谁是负的所有5 LBBB classification.Conclusions：这项研究表明，LBBB与CRT的结果的关联强度取决于用于定义LBBB的ECG分类，最简单的标准（ESC 2009年和2013年）提供了最佳的CRT临床终点的关联。(c)2018爱思唯尔B. V.保留所有权利。
Background: CRT has been proven to achieve most benefit in patients with left bundle branch block morphology (LBBB). However, ECG criteria to define LBBB significantly differ from each other. Objective of the study was to evaluate the impact of different ECG criteria for LBBB definition on survival, hospitalization for heart failure and reverse remodelling in patients who received cardiac resynchronization therapy (CRT).Methods and results: Three-hundred-sixteen consecutive patients were included in the analysis. Six different classifications were assessed in baseline ECGs of patients who received a CRT device: a QRS duration of >= 150 ms and LBBB according to AHA/ACC/HRS, ESC 2006, ESC 2009, ESC 2013 and the classification proposed by Strauss and colleagues. In univariate analysis, the ESC 2009 and 2013 and the Strauss classifications were significantly associated with a reduction in cumulative probability for heart failure (HF) andmortality (HR 0.60, 95% CI 0.42-0.86, HR 0.61, 95% CI 0.43-0.87 and HR 0.57, 95% CI 0.40-0.80, respectively). Inmultivariate analysis, the association with the combined endpoint was confirmed only for ESC 2009 and 2013 classifications and for Strauss. Moreover, the cumulative probability of all-cause death and HF hospitalizations was higher in patients who were negative for all the 5 LBBB classifications.Conclusions: This study shows that the strength of the association of LBBB to outcome in CRT depends on the ECG classifications used to define LBBB, the simplest criteria (ESC 2009 and 2013) providing the best association with clinical endpoints in CRT. (c) 2018 Elsevier B.V. All rights reserved.