Abstract：
Patients with a class I recommendation for cardiac resynchronization therapy (CRT) are likely to benefit, but the effect of CRT in class II patients is more heterogeneous and additional selection parameters are needed in this group. The recently validated segment length in cine strain analysis of the septum (SLICE-ESSsep) measurement on cardiac magnetic resonance cine imaging predicts left ventricular functional recovery after CRT but its prognostic value is unknown. This study sought to evaluate the prognostic value of SLICE-ESSsep for clinical outcome after CRT.
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.
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.
摘要：
心脏再同步治疗（CRT）的I类推荐患者可能受益，但在II类患者中,CRT的效果更为异质性,这一组还需要额外的选择参数.心脏磁共振电影成像的电影应变分析（SLICE-ESSsep）测量中最近验证的段长度可预测CRT后左心室功能恢复，但其预后价值未知。本研究旨在评估SLICE-ESSsep对CRT后临床结局的预后价值。
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。
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。
