Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry
Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry
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DOI：
10.1093/europace/eup038
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发表时间：
2009-03-01
期刊：
影响因子：
6.1
通讯作者：
Providencia, Luis A.
中科院分区：
文献类型：
--
作者：
Antonio, Natalia;Teixeira, Rogerio;Providencia, Luis A.
一些患者在心脏再同步治疗（CRT）后表现出如此重要的临床改善和逆转重塑，以至于解剖和功能接近正常。这些患者被称为“超级反应者”。我们研究的目的是确定 CRT 后成为超级反应者的预测因素。对 87 名连续接受 CRT 的患者进行了前瞻性研究。 CRT 前和 6 个月后，进行临床和超声心动图评估。纽约心脏协会功能分级降低>=1、左心室射血分数(LVEF)增加两倍或更多或最终LVEF>45%、左心室收缩末期容量减少>15%的患者被归类为超级反应者。有 12% 的超级响应者。在基线时，超级反应者与其他患者之间没有显着差异，除了超级反应者的二尖瓣反流和左心室舒张末期内径（LVEDD）明显较小以及心力衰竭症状持续时间较短这一事实之外。二尖瓣反流射流面积、LVEDD 和心力衰竭症状持续时间与这种超级反应相关。此外，症状的演变时间<12个月是对CRT超级反应的独立预测因素。处于心肌病早期阶段的患者，心室几何形状改变较小，似乎更有可能成为超级反应者。
Some patients show such an important clinical improvement and reverse remodelling after cardiac resynchronization therapy (CRT) that anatomy and function approach normal. These patients have been called 'super-responders'. The aim of our study was to identify predictors of becoming a super-responder after CRT.Eighty-seven consecutive patients who underwent CRT were prospectively studied. Before CRT and 6 months after, clinical and echocardiographic evaluation was performed. Patients with a decrease in New York Heart Association functional class >= 1, a two-fold or more increase of left ventricular ejection fraction (LVEF) or a final LVEF > 45%, and a decrease in LV end-systolic volume > 15% were classified as super-responders. There were 12% super-responders. At baseline, there were no significant differences between super-responders and the other patients, except for the fact that super-responders had significantly smaller mitral regurgitation and LV end-diastolic diameter (LVEDD) and a shorter duration of heart failure symptoms. Mitral regurgitation jet area, LVEDD, and duration of heart failure symptoms were correlated with this super-response. Moreover, an evolution of symptoms for < 12 months was an independent predictor of super-response to CRT.Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.