Cardiac resynchronization therapy guided by multimodality cardiac imaging
Cardiac resynchronization therapy guided by multimodality cardiac imaging
复制标题
多模态心脏成像引导下的心脏再同步化治疗
DOI：
10.1002/ejhf.605
复制
发表时间：
2016-11-01
影响因子：
18.2
通讯作者：
Ferrari, Roberto
中科院分区：
文献类型：
--
作者：
Bertini, Matteo;Mele, Donato;Ferrari, Roberto
目的高达30-45%的植入患者对CRT无反应。我们评估了CRT团队的作用，使用心脏磁共振（CMR）和纵向心肌应变，以确定目标区域定义为最延迟和可行的区域LV pacing.Methods和resultsA共100名心力衰竭患者的CRT分为两组的候选人。第1组由50例计划接受CRT的连续患者组成，并前瞻性纳入。第2组（对照组）包括50例根据标准临床实践植入CRT器械的患者，年龄、性别和LVEF与第1组匹配。在基线和6个月随访时对患者进行评价。在第1组中，患者接受了纵向心肌应变的二维斑点追踪评估和CMR成像，以确定LV电极导线起搏的靶区域。CRT的阳性反应定义为6个月随访时LV收缩末期容积减少15%。第1组中共有39例（78%）患者被归类为CRT应答者，而第2组中仅28例（56%）为应答者（P = 0.019）。CRT团队确定30例（60%）患者的外侧区域和12例（24%）患者的前外侧或后外侧区域为LV起搏的目标。在8例（16%）患者中，靶点远离外侧区域，位于前部或后部区域。结论多模态心脏显像对CRT植入术有指导作用，可提高CRT植入术的有效率。
AimsUp to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing.Methods and resultsA total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of 15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT.ConclusionsMultimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate.