与心脏再同步化治疗血流动力学阳性反应相关的因素

A. Nechepurenko, N. Ilov, Dmitry A. Zorin, Eugeny I. Romantcov, O. V. Palnikova
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引用次数: 0

摘要

目的:本研究旨在对慢性心力衰竭(CHF)患者对心脏再同步化(CRT)有不同血流动力学反应的临床、心电图和超声心动图因素进行比较分析,以评估其用于预测CRT积极作用的可能性。材料与方法:研究纳入136例左心室射血分数为35%、QRS持续时间为150 ms、QRS持续时间为130149 ms、QRS形态为左束支阻滞(LBBB)的纽约心脏协会34级CHF患者。为了治疗CHF和主要预防心源性猝死,植入具有CRT (CRT- d)功能的心脏转复除颤器。对入组患者进行1年的前瞻性随访,记录终点,即对CRT的血流动力学反应,通过左心室收缩末期容积减少15%来评估。结果:在1年的随访中,62例(46%)患者登记了主要终点。通过单向logistic回归,确定了4个预测潜力最高的指标(p 0.05),并与研究终点的发生相关。根据多变量回归分析的结果,我们建立了一个预后模型,其中包括三个具有最高统计意义的因素,即先前瓣膜功能不全纠正的适应症史,QRS持续时间和根据Strauss的LBBB标准。该模型的诊断效率为73%(灵敏度为80%;特异性,68%)。Strauss LBBB标准的心电图参数和QRS持续时间是研究终点的独立预测因子。结论:建立的多变量预后模型可用于选择CHF低射血分数患者植入具有CRT功能的装置;缺乏外部验证限制了其在实践中的应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Associated with a Positive Hemodynamic Response to Cardiac Resynchronization Therapy
AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT. MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 34 CHF with a left ventricular ejection fraction of 35%, QRS duration of 150 ms, QRS duration of 130149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by 15%. RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint. CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.
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