Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy
Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy
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DOI：
10.1016/j.jacc.2008.06.046
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发表时间：
2008-10-21
影响因子：
24
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Ypenburg, Claudia;van Bommel, Rutger J.;Bax, Jeroen J.
目的 本研究的目的是评估心脏再同步治疗 (CRT) 6 个月后的超声心动图参数，以及左心室 (LV) 导联位于最新激活部位（左心室导联位置一致）的患者与左心室导联位置不一致的患者的长期结果。背景 非最佳 LV 起搏导联位置可能是对 CRT 无反应的潜在原因。方法 最近机械激活部位通过散斑跟踪径向应变分析确定，并与 244 名 CRT 候选者胸部 X 光片上的 LV 导联位置相关。 6个月后进行超声心动图评估。长期随访包括全因死亡率和因心力衰竭住院治疗。 结果 在左心室导联位置一致的患者组 (n = 153, 63%) 中发现了显着的左室逆转重塑（左心室收缩末期容积从 189 +/- 83 ml 减少到 134 +/- 71 ml，p < 0.001），而左心室导联位置不一致的患者则没有出现这种情况。重大改进。此外，在长期随访（32 +/- 16 个月）期间，左心室导联位置一致的患者报告的事件（合并心力衰竭住院和死亡）较少。此外，一致的左心室导联位置似乎是长期 CRT 后无住院生存的独立预测因素（风险比：0.22，p = 0.004）。结论 根据散斑跟踪径向应变分析确定，在最新机械激活部位起搏可在 6 个月的 CRT 后产生优异的超声心动图反应，并在长期随访期间实现更好的预后。 (J Am Coll Cardiol 2008; 52: 1402 -9) (C) 2008 年，美国心脏病学会基金会
Objectives The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.Background A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.Methods The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.Results Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 +/- 83 ml to 134 +/- 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 +/- 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004).Conclusions Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. (J Am Coll Cardiol 2008; 52: 1402 -9) (C) 2008 by the American College of Cardiology Foundation