OBJECTIVE: The purpose of this study was to investigate the clinical impact of the modified QRSd on the efficacy of CRT in patients with \"mid-range\" QRSd.
METHODS: We conducted a retrospective, multicenter, observational study, with heart failure hospitalization (HFH) after CRT as the primary endpoint. Modified QRSd is defined as QRSd divided by LVEDV, determined through the Teichholtz method of echocardiography.
RESULTS: Among the 506 consecutive patients considered, 119 (mean age 61 ± 15 years; 80% male, QRSd 135 ± 9 ms) with a \"mid-range\" QRSd who underwent de novo CRT device implantation were included for analysis. During median follow-up of 878 days [interquartile range 381-1663 days], HFH occurred in 45 patients (37%). Fine-Gray analysis revealed modified QRSd was an independent predictor of HFH (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.96-0.99; P <.01). Receiver operating characteristic curve analysis revealed a cutoff value of 0.65 ms/mL for the modified QRSd in predicting HFH. Patients above the threshold exhibited a significantly lower incidence of HFH than patients below the threshold (HR 0.46; 95% CI 0.25-0.86; P = .01).
CONCLUSIONS: Modified QRSd can effectively predict the efficacy of CRT in patients with a \"mid-range\" QRSd.
目的:研究改良QRSd对“中程”QRSd患者CRT疗效的临床影响。
方法:我们进行了回顾性研究,多中心,观察性研究,以CRT后心力衰竭住院(HFH)为主要终点。修改后的QRSd定义为QRSd除以LVEDV,通过Teichholtz超声心动图方法测定。
结果:在考虑的506名连续患者中,119例患者(平均年龄:61±15岁,80%男性,QRSd:135±9ms)和“中档”QRSd,接受了从头CRT装置植入,用于分析。在878天的中位随访期间(四分位距:381-1663天),45例(37%)患者发生HFH。Fine-Gray分析显示改良QRSd是HFH的独立预测因子(风险比[HR]:0.97,95%置信区间[CI]:0.96-0.99,p<0.01)。接收器工作特征曲线分析显示,改良QRSd预测HFH的截止值为0.65ms/mL。与以下患者相比,上述患者的HFH发生率显着降低(HR:0.46,95%CI:0.25-0.86,p=0.01)。
结论:改良QRSd可有效预测“中程”QRSd患者的CRT疗效。