Two hundred eighteen patients with a left bundle branch block or intraventricular conduction delay and a class I or class II indication for CRT who underwent preimplantation cardiovascular magnetic resonance examination were enrolled. SLICE-ESSsep was manually measured on standard cardiovascular magnetic resonance cine imaging. The primary combined end point was all-cause mortality, left ventricular assist device, or heart transplantation. Secondary end points were (1) appropriate implantable cardioverter defibrillator therapy and (2) heart failure hospitalization.
Two-thirds (65%) of patients had a positive SLICE-ESSsep ≥0.9% (ie, systolic septal stretching). During a median follow-up of 3.8 years, 66 (30%) patients reached the primary end point. Patients with positive SLICE-ESSsep were at lower risk to reach the primary end point (hazard ratio 0.36; P<0.001) and heart failure hospitalization (hazard ratio 0.41; P=0.019), but not for implantable cardioverter defibrillator therapy (hazard ratio, 0.66; P=0.272). Clinical outcome of class II patients with a positive ESSsep was similar to those of class I patients (hazard ratio, 1.38 [95% CI, 0.66-2.88]; P=0.396).
Strain assessment of the septum (SLICE-ESSsep) provides a prognostic measure for clinical outcome after CRT. Detection of a positive SLICE-ESSsep in patients with a class II indication predicts improved CRT outcome similar to those with a class I indication whereas SLICE-ESSsep negative patients have poor prognosis after CRT implantation.
纳入有左束支传导阻滞或心室内传导延迟且有I类或II类CRT指征且接受植入前心血管磁共振检查的患者。在标准心血管磁共振电影成像上手动测量SLICE-ESSsep。主要的综合终点是全因死亡率,左心室辅助装置,或者心脏移植.次要终点是(1)适当的植入式心脏复律除颤器治疗和(2)心力衰竭住院。
三分之二(65%)的患者SLICE-ESSsep阳性≥0.9%(即,收缩期间隔拉伸)。在3.8年的中位随访期间,66例(30%)患者到达主要终点。SLICE-ESSsep阳性的患者达到主要终点的风险较低(风险比0.36;P<0.001),心力衰竭住院的风险较低(风险比0.41;P=0.019)。但不适用于植入式心律转复除颤器治疗(危险比,0.66;P=0.272)。ESSsep阳性的II类患者的临床结果与I类患者相似(风险比,1.38[95%CI,0.66-2.88];P=0.396)。
隔膜的应变评估(SLICE-ESSsep)为CRT后的临床结果提供了一种预后指标。在II类适应症患者中检测到SLICE-ESSsep阳性可预测CRT结局改善,与I类适应症相似,而SLICE-ESSsep阴性患者在CRT植入后预后不良。