Prognostic Benefit of Optimum Left Ventricular Lead Position in Cardiac Resynchronization Therapy
Prognostic Benefit of Optimum Left Ventricular Lead Position in Cardiac Resynchronization Therapy
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DOI：
10.1016/j.jchf.2013.11.010
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发表时间：
2014-06-01
影响因子：
13
通讯作者：
Dutka, David P.
中科院分区：
文献类型：
--
作者：
Kydd, Anna C.;Khan, Fakhar Z.;Dutka, David P.
目的 本研究旨在评估左心室 (LV) 导联位置对心脏再同步治疗 (CRT) 后长期生存的影响。背景 CRT 中最佳的 LV 导联位置与临床结果的改善相关。斑点跟踪超声心动图策略可用于引导植入者到达最近激活的部位并远离低应变幅度（疤痕）的部分。根据 CRT 中左心室主导位置得出的长期、前瞻性生存数据是有限的。方法对 2008 年 6 月至 2010 年 7 月期间接受 CRT 的 250 名连续患者的随访登记数据进行了研究。研究人群包括招募到衍生组和随后的 TARGET（指导心脏再同步治疗的靶向左心室导线放置）随机对照试验的患者。最终左心室导联位置与术前斑点追踪超声心动图确定的起搏部位相关，被描述为最佳（一致/相邻）或次优（远程）。随访时记录全因死亡率。结果 最佳左心室导联位置 (n = 202) 的左室重塑反应优于次优导联位置（左心室收缩末期容积变化：-24 +/- 15% 对比 -12 +/- 17% [p < 0.001]；射血分数变化：+7 +/- 8% 对比 +4 +/- 7% [p = 0.02]）。在长期随访期间（中位时间：39 个月；范围：< 1 至 61 个月），最佳左心室导联位置与生存率改善相关（对数秩 p = 0.003）。次优的 LV 导线放置位置可独立预测全因死亡率（风险比：1.8；p = 0.024）。结论 最佳的 LV 导线位置位于最近机械激活部位，避免低应变幅度（疤痕），与卓越的 CRT 反应和随访期间持续改善的生存率相关。 (C) 2014 年，美国心脏病学会基金会
Objectives This study was conducted to assess the impact of left ventricular (LV) lead position on longer-term survival after cardiac resynchronization therapy (CRT).Background An optimal LV lead position in CRT is associated with improved clinical outcome. A strategy of speckle-tracking echocardiography can be used to guide the implanter to the site of latest activation and away from segments of low strain amplitude (scar). Long-term, prospective survival data according to LV lead position in CRT are limited.Methods Data froma follow-up registry of 250 consecutive patients receiving CRT between June 2008 and July 2010 were studied. The study population comprised patients recruited to the derivation group and the subsequent TARGET (Targeted Left Ventricular Lead Placement to guide Cardiac Resynchronization Therapy) randomized, controlled trial. Final LV lead position was described, in relation to the pacing site determined by pre-procedure speckle-tracking echocardiography, as optimal (concordant/adjacent) or suboptimal (remote). All-cause mortality was recorded at follow-up.Results An optimal LV lead position (n = 202) conferred LV remodeling response superior to that of a suboptimal lead position (change in LV end-systolic volume: -24 +/- 15% vs. -12 +/- 17% [p < 0.001]; change in ejection fraction: +7 +/- 8% vs. +4 +/- 7% [p = 0.02]). During long-term follow-up (median: 39 months; range: < 1 to 61 months), an optimal LV lead position was associated with improved survival (log-rank p = 0.003). A suboptimal LV lead placement independently predicted all-cause mortality (hazard ratio: 1.8; p = 0.024).Conclusions An optimal LV lead position at the site of latest mechanical activation, avoiding low strain amplitude (scar), was associated with superior CRT response and improved survival that persisted during follow-up. (C) 2014 by the American College of Cardiology Foundation