新的心电图非同步化标准可能改善患者对心脏再同步化治疗的选择

G. Katona, A. Vereckei
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引用次数: 2

摘要

心脏再同步化治疗(CRT)是一种循证有效的治疗伴有射血分数降低的症状性心力衰竭的方法,这种心力衰竭与室内传导障碍相关,导致电非同步化和收缩期心室功能进一步恶化。然而,对CRT的无反应率仍为20% - 40%,通过更好的患者选择可以降低这一比例。CRT结果的主要决定因素是是否存在显著的心室非同步化以及应用CRT技术消除它的能力。目前的指南推荐QRS形态学和QRS持续时间的测定以及左心室射血分数的测量来选择CRT患者。然而,QRS形态学和QRS持续时间并不是电不同步的完美指标,这是导致CRT无反应率不可忽视的原因,并且在相当多的患者中有合适的CRT底物而未能植入CRT。使用成像方式,许多心室非同步化标准被设计用于检测机械非同步化,但它们在选择CRT患者中的作用尚未得到证实,因此不推荐用于此目的。此外,CRT只能消除由于潜在的电非同步性引起的机械非同步性,因此ECG在检测心室非同步性方面比成像方式具有更大的作用。为了改善电非同步化的评估,我们设计了两个新的ECG非同步化标准,可以评估室间和左室内非同步化,以改善患者对CRT的选择。在这里,我们讨论了这些新的ECG非同步化标准的应用所取得的结果,这些标准被证明有助于预测非特异性脑室内传导障碍模式(第二大CRT候选者)患者的CRT反应,以及其他新的ECG非同步化标准在改善CRT结果方面的潜在意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel electrocardiographic dyssynchrony criteria that may improve patient selection for cardiac resynchronization therapy
Cardiac resynchronization therapy (CRT) is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction refractory to optimal medical treatment associated with intraventricular conduction disturbance, that results in electrical dyssynchrony and further deterioration of systolic ventricular function. However, the non-response rate to CRT is still 20%−40%, which can be decreased by better patient selection. The main determinant of CRT outcome is the presence or absence of significant ventricular dyssynchrony and the ability of the applied CRT technique to eliminate it. The current guidelines recommend the determination of QRS morphology and QRS duration and the measurement of left ventricular ejection fraction for patient selection for CRT. However, QRS morphology and QRS duration are not perfect indicators of electrical dyssynchrony, which is the cause of the not negligible non-response rate to CRT and the missed CRT implantation in a significant number of patients who have the appropriate substrate for CRT. Using imaging modalities, many ventricular dyssynchrony criteria were devised for the detection of mechanical dyssynchrony, but their utility in patient selection for CRT is not yet proven, therefore their use is not recommended for this purpose. Moreover, CRT can eliminate only mechanical dyssynchrony due to underlying electrical dyssynchrony, for this reason ECG has a greater role in the detection of ventricular dyssynchrony than imaging modalities. To improve assessment of electrical dyssynchrony, we devised two novel ECG dyssynchrony criteria, which can estimate interventricular and left ventricular intraventricular dyssynchrony in order to improve patient selection for CRT. Here we discuss the results achieved by the application of these new ECG dyssynchrony criteria, which proved to be useful in predicting the CRT response in patients with nonspecific intraventricular conduction disturbance pattern (the second greatest group of CRT candidates), and the significance of other new ECG dyssynchrony criteria in the potential improvement of CRT outcome.
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