Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy.
Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy.
复制标题
心房逆重构与心脏再同步治疗的结果相关。
作者：
M. Kloosterman;M. Rienstra;B. Mulder;I. V. Van Gelder;A. Maass
旨在
探讨心房逆转重构对心脏起搏治疗（CRT）预后的影响。
方法和结果
纳入了在格罗宁根大学医学中心接受CRT器械的患者。心房逆向重构定义为6个月随访时左心房容积指数降低≥10%。CRT的成功定义为心室逆转重构，6个月随访时左心室收缩末期容积减少≥15%。主要终点是全因死亡率或心力衰竭住院。共纳入365例患者（平均年龄65.1 ± 11.0岁，73%为男性）;其中221例（61%）为窦性心律，既往无房颤（AF），144例（39%）有AF病史。平均随访2.0 ± 1.0年，49例患者死亡。考克斯回归分析显示，无心房和心室逆转重构的患者结局最差（风险比3.1，95%置信区间1.4-7.1，P = 0.006）。仅心房逆向重构患者的结局与心房和心室逆向重构患者的结局相似（风险比2.0，95%置信区间0.7-5.6，P = 0.21）。
结论
无心房和心室逆向重构的患者预后最差。仅心房逆向重构的患者在随访期间改善了左心室舒张期充盈，并显示出与心房和心室逆向重构患者相当的结局。评估心房逆向重构可能为确定CRT结局提供额外的预后信息。
AIMS
To study the prognostic effect of atrial reverse remodelling on outcome of cardiac resynchronization therapy (CRT).
METHODS AND RESULTS
Patients receiving a CRT device in the University Medical Centre Groningen were included. Atrial reverse remodelling was defined as a ≥10% reduction in left atrial volume index at 6-month follow-up. Success of CRT was defined as ventricular reverse remodelling with a reduction in left ventricular end-systolic volume of ≥15% at 6-month follow-up. Primary endpoint was all-cause mortality or heart failure hospitalizations. A total of 365 patients (mean age 65.1 ± 11.0 years, 73% men) were included; among them, 221 (61%) were in sinus rhythm and had no prior atrial fibrillation (AF), and 144 patients (39%) had a history of AF. During a mean follow up of 2.0 ± 1.0 years, 49 patients died. Cox regression analysis revealed that patients with no atrial and no ventricular reverse remodelling had the worst outcome (hazard ratio 3.1, 95% confidence interval 1.4-7.1, P = 0.006). Outcome in patients with only atrial reverse remodelling was comparable with outcome in patients with both atrial and ventricular reverse remodelling (hazard ratio 2.0, 95% confidence interval 0.7-5.6, P = 0.21).
CONCLUSION
Patients without atrial and ventricular reverse remodelling have the worst outcome. Patients with only atrial reverse remodelling have improved left ventricular diastolic filling during follow-up and demonstrate a comparable outcome with patients with both atrial and ventricular reverse remodelling. Assessment of atrial reverse remodelling may provide additional prognostic information in determining CRT outcome.
影响因子：
24
作者：
Pritchett, AM;Mahoney, DW;Redfield, MM
通讯作者：
Redfield, MM