Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization Therapy A Randomized Study
Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization Therapy A Randomized Study
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DOI：
10.1016/j.jacep.2017.11.020
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发表时间：
2018-02-01
影响因子：
7
通讯作者：
Mont, Lluis
中科院分区：
文献类型：
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作者：
Trucco, Emilce;Maria Tolosana, Jose;Mont, Lluis
本研究的目的是比较采用融合优化房室间隔（AV）和室间间隔（VV）与标称设置的患者对心脏再同步化治疗（CRT）的反应。背景：在接受CRT的患者中，AV-和vv -间隔优化所获得的额外益处仍然存在争议。先前的研究显示血液动力学参数的短期益处；然而，缺乏心电图优化和标称参数之间的中期随机比较。方法180例连续接受CRT治疗的左束支阻滞患者随机分为融合优化间隔（FOI）和标称间隔。在FOI组，根据最窄QRS优化AV和VV间隔，采用融合与本征传导。临床缓解被定义为在6分钟步行试验中增加bbb10 %或在纽约心脏协会功能分级中增加1步。随访12个月，左室收缩末期容积（LVESV）下降15%为左室重构。此外，LVESV相对于基线降低30%的患者被认为是超级应答者；相比之下，阴性应答者的LVESV相对于基线增加。结果：参与者的平均年龄为65 +/- 10岁，68%为男性，37%患有缺血性心肌病，左室射血分数26 +/- 7%，QRS 180 +/- 22 ms。与标称设置相比，FOI显著缩短了基线QRS（分别为56.55 +/- 17.65 ms和37.81 +/- 22.07 ms, p = 0.025）。12个月时，FOI组中更大比例的患者实现了左室逆转重构(74%对53%[优势比：2.02(95%可信区间：1.08 ~ 3.76)]；P = 0.026)。两组的临床反应无显著差异(61% vs. 53%[比值比：1.43(95%可信区间：0.79 ~ 2.59)]；P = 0.24)。结论：与常规设置相比，基于FOI的设备优化实现了更大的左室重构。（心电图优化的CRT：中期反应的评估[BEST]； NCT01439529） (c) 2018由美国心脏病学会基金会。
OBJECTIVES The aim of this study was to compare patient response to cardiac resynchronization therapy (CRT) using fusion-optimized atrioventricular (AV) and interventricular (VV) intervals versus nominal settings.BACKGROUND The additional benefit obtained by AV- and VV-interval optimization in patients undergoing CRT remains controversial. Previous studies show short-term benefit in hemodynamic parameters; however, midterm randomized comparison between electrocardiogram optimization and nominal parameters is lacking.METHODS A group of 180 consecutive patients with left bundle branch block treated with CRT were randomized to fusion-optimized intervals (FOI) or nominal settings. In the FOI group, AV and VV intervals were optimized according to the narrowest QRS, using fusion with intrinsic conduction. Clinical response was defined as an increase >10% in the 6-min walk test or an increment of 1 step in New York Heart Association functional class. The left ventricular (LV) remodeling was defined as >15% decrease in left ventricular end-systolic volume (LVESV) at 12-month follow-up. Additionally, patients with LVESV reduction >30% relative to baseline were considered super-responders; by contrast, negative responders had increased LVESV relative to baseline.RESULTS Participant characteristics included a mean age of 65 +/- 10 years, 68% male, 37% with ischemic cardiomyopathy, LV ejection fraction 26 +/- 7%, and QRS 180 +/- 22 ms. Baseline QRS was shortened significantly more by FOI, compared with nominal settings (similar to 56.55 +/- 17.65 ms vs. similar to 37.81 +/- 22.07 ms, respectively; p = 0.025). At 12 months, LV reverse remodeling was achieved in a larger proportion of the FOI group (74% vs. 53% [odds ratio: 2.02 (95% confidence interval: 1.08 to 3.76)], respectively; p = 0.026). No significant differences were observed in clinical response (61% vs. 53% [odds ratio: 1.43 (95% confidence interval: 0.79 to 2.59)], respectively; p = 0.24).CONCLUSIONS Device optimization based on FOI achieves greater LV remodeling, compared with nominal settings. (ECG Optimization of CRT: Evaluation of Mid-Term Response [BEST]; NCT01439529) (c) 2018 by the American College of Cardiology Foundation.