Novel measure of electrical dyssynchrony predicts response in cardiac resynchronization therapy: Results from the SMART-AV Trial.
Novel measure of electrical dyssynchrony predicts response in cardiac resynchronization therapy: Results from the SMART-AV Trial.
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DOI：
10.1016/j.hrthm.2015.08.009
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发表时间：
2015-12
期刊：
影响因子：
5.5
通讯作者：
SMART-AV Trial Investigators
中科院分区：
文献类型：
--
作者：
Tereshchenko LG;Cheng A;Park J;Wold N;Meyer TE;Gold MR;Mittal S;Singh J;Stein KM;Ellenbogen KA;SMART-AV Trial Investigators
心脏再同步治疗（CRT）可降低特定心力衰竭（HF）患者的死亡率和发病率。然而，并非所有患者都对 CRT 有反应。我们假设电不同步的一种新测量方法，绝对 QRST 积分总和 (SAI)，可以预测独立于 QRS 持续时间和形态的 CRT 反应。我们回顾性分析了 SMART-AV 研究参与者的基线 12 导联心电图 (ECG) [N=234，平均年龄 67 岁，70% 男性，60% 缺血性心肌病 (ICM)，平均左心室射血分数 (LVEF) 25%，平均 QRS 持续时间 152ms，77% 患有左束支传导阻滞 (LBBB)]。植入前基线心电图被数字化，转换为正交 XYZ，并通过定制的 Matlab 软件自动分析。 SAI 被测量为 QRST 曲线下绝对面积的平均算术和。 CRT-D 植入后 6 个月对患者进行前瞻性随访。 CRT 6 个月后左心室收缩末期容积减少 ≥ 15ml 的患者被视为有反应者。 Logistic回归模型根据年龄、性别、BBB形态、LVEF、心肌病类型和QRS时限进行调整。平均 SAI（第三个三分位数）较高的患者的缓解几率比平均 SAI 较低的患者（第一个三分位数；OR 2.5，95% CI 1.3-5.0，p=0.010）高 2.5 倍，比较低的两个三分位数组合高 1.9 倍（OR 1.9，95% CI 1.1-3.5；P=0.03）。调整肾功能（OR 2.33 (95%CI 1.32, 4.11)；P=0.003）和RAO/LAO中左心室导联位置（OR 1.7 (95%CI 0.9, 3.2)；P=0.087）并没有减弱SAI与结果的关联。在 SMART-AV 研究中，高 SAI QRST 独立预测 CRT 反应。
Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected heart failure (HF) patients. However, not all patients respond to CRT. We hypothesized that a novel measure of electrical dyssynchrony, sum absolute QRST integral (SAI), predicts CRT response independent of QRS duration and morphology. We retrospectively analyzed baseline 12-lead electrocardiograms (ECGs) of SMART-AV study participants [N=234, mean age 67 y, 70% male, 60% ischemic cardiomyopathy (ICM), mean left ventricular ejection fraction (LVEF) 25%, mean QRS duration 152ms, 77% had left bundle branch block (LBBB)]. Baseline pre-implant ECGs were digitized, transformed into orthogonal XYZ, and analyzed automatically by customized Matlab software. SAI was measured as an averaged arithmetic sum of absolute areas under the QRST curve. Patients were followed prospectively 6 months after CRT-D implantation. Patients with a decrease in left ventricular end-systolic volume ≥ 15mls after 6 months of CRT were considered responders. Logistic regression model was adjusted for age, gender, BBB morphology, LVEF, type of cardiomyopathy and QRS duration. Patients with the high mean SAI (3rd tertile) had 2.5 times greater odds of response than those with low mean SAI (1st tertile; OR 2.5, 95% CI 1.3–5.0, p=0.010), and 1.9 times greater than the lower two tertiles combined (OR 1.9, 95%CI 1.1–3.5; P=0.03). Adjustment for renal function (OR 2.33 (95%CI 1.32, 4.11); P=0.003) and LV lead position in RAO/LAO (OR 1.7 (95%CI 0.9, 3.2); P=0.087) did not attenuate association of SAI with outcome. High SAI QRST independently predicts CRT response in the SMART-AV study.