Impact of mechanical activation, scar, and electrical timing on cardiac resynchronization therapy response and clinical outcomes.
Impact of mechanical activation, scar, and electrical timing on cardiac resynchronization therapy response and clinical outcomes.
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机械激活，疤痕和电时机对心脏重新同步治疗反应和临床结果的影响。
DOI：
10.1016/j.jacc.2014.02.533
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发表时间：
2014-04-29
影响因子：
24
通讯作者：
Epstein, Frederick H.
中科院分区：
文献类型：
--
作者：
Bilchick, Kenneth C.;Kuruvilla, Sujith;Hamirani, Yasmin S.;Ramachandran, Raghav;Clarke, Samantha A.;Parker, Katherine M.;Stukenborg, George J.;Mason, Pamela;Ferguson, John D.;Moorman, J. Randall;Malhotra, Rohit;Mangrum, J. Michael;Darby, Andrew E.;DiMarco, John;Holmes, Jeffrey W.;Salerno, Michael;Kramer, Christopher M.;Epstein, Frederick H.
使用心脏磁共振（CMR），我们试图评估机械，电气和疤痕属性在左心室（LV）电极导线位置（LVLP）的CRT反应和临床事件的相对影响。CMR电影位移编码与刺激回波（DENSE）为整体不同步（环周均匀性比估计值[CURE，0-1]）和LVLP环周收缩开始时间提供高质量应变。CMR DENSE、晚期钆增强和电定时联合使用可以改善其他成像方式，以评估最佳LVLP。患者在CRT前进行了完整的CMR研究和超声心动图检查。CRT反应定义为LV收缩末期容积减少15%。电激活被评估为从QRS发作到LVLP电描记图（QLV）的时间。然后对患者进行临床事件随访。在75例患者中，多变量logistic模型准确识别了40例（53%）CRT反应患者（AUC=0.95 [p<0.0001]），基于CURE（OR 2.59/0.1降低）、LVLP时延迟的环周收缩发作（OR 6.55）、无LVLP瘢痕（OR 14.9）和QLV（OR 1.31/10 ms增加）。33%的CURE<0.70、无LVLP瘢痕和LVLP收缩延迟发作的患者有100%的反应率，而CURE≥0.70的患者CRT反应率为0%，死亡风险增加12倍，其余患者的反应特征混合。LVLP的机械、电气和瘢痕特性以及CMR机械不同步性与超声心动图CRT反应和CRT后的临床事件密切相关。对这些发现进行建模有望改善CRT结局。
Using cardiac magnetic resonance (CMR), we sought to evaluate the relative influences of mechanical, electrical, and scar properties at the left ventricular (LV) lead position (LVLP) on CRT response and clinical events. CMR cine displacement encoding with stimulated echoes (DENSE) provides high quality strain for overall dyssynchrony (circumferential uniformity ratio estimate [CURE, 0–1]) and timing of onset of circumferential contraction at the LVLP. CMR DENSE, late gadolinium enhancement, and electrical timing together could improve upon other imaging modalities for evaluating the optimal LVLP. Patients had complete CMR studies and echocardiography before CRT. CRT response was defined as a 15% reduction in LV end-systolic volume. Electrical activation was assessed as the time from QRS-onset-to-LVLP-electrogram (QLV). Patients were then followed for clinical events. In 75 patients, multivariable logistic modeling accurately identified the 40 (53%) of patients with CRT response (AUC=0.95 [p<0.0001]) based on CURE (OR 2.59/0.1 decrease), delayed circumferential contraction onset at LVLP (OR 6.55), absent LVLP scar (OR 14.9), and QLV (OR 1.31/10 ms increase). The 33% of patients with CURE<0.70, absence of LVLP scar, and delayed LVLP contraction onset had a 100% response rate, whereas those with CURE≥0.70 had a 0% CRT response rate and a 12-fold increased risk of death, and the remaining patients had a mixed response profile. Mechanical, electrical, and scar properties at the LVLP together with CMR mechanical dyssynchrony are strongly associated with echocardiographic CRT response and clinical events after CRT. Modeling these findings holds promise for improving CRT outcomes.
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影响因子：
3.7
作者：
Bilchick, Kenneth C;Helm, Robert H;Kass, David A
通讯作者：
Kass, David A
影响因子：
14
作者：
Budge, Loren P.;Helms, Adam S.;Salerno, Michael;Kramer, Christopher M.;Epstein, Frederick H.;Bilchick, Kenneth C.
通讯作者：
Bilchick, Kenneth C.
影响因子：
24
作者：
Khan, Fakhar Z.;Virdee, Mumohan S.;Dutka, David P.
通讯作者：
Dutka, David P.
影响因子：
19.7
作者：
Ernande, Laura;Thibault, Helene;Croisille, Pierre
通讯作者：
Croisille, Pierre
影响因子：
24
作者：
Gorcsan, John, III;Tanabe, Masaki;Bax, Jeroen J.
通讯作者：
Bax, Jeroen J.