■先前的研究表明,尽管遵循当前的患者选择指南,仍有30%~40%的患者在接受心脏再同步治疗(CRT)后心力衰竭(HF)未得到改善.我们旨在利用超声心动图心肌工作参数作为心力衰竭和射血分数降低(HFrEF)患者对CRT反应的预测因子。
■我们前瞻性招募了2019年6月至2022年9月在孙逸仙纪念医院接受CRT的患者。全面的术前信息,临床实验室数据,收集所有参与者的常规超声心动图参数和心肌功,以及CRT后6个月的随访数据。
■25例患者(67.6%)对CRT治疗有反应,而12例患者(32.4%)无反应。与无反应组相比,响应组具有更大的区域建设性工作[RCW:基底9段的建设性工作(CW)的总和,mid,和前段的顶端,横向,和后壁],区域浪费的工作[RWW:前间隔的基底和中段的6个节段中的浪费的工作(WW)的总和,后隔和前壁],以及基线中RCW和RWW的组合(RCW+RWW)(RCW:9,695.68±2,955.40vs.5,219.50±2,207.68mmHg,P<0.001;RWW:3,612.08±1,723.80vs.1,674.33±995.23mmHg%,P=0.001;RCW+RWW:13,307.76±3,857.71vs.6,893.83±2,592.83mmHg,P<0.001)。此外,全球建设性工作(GCW),全球浪费工作(GWW),GCW+GWW,RCW,RWW,和RCW+RWW的受试者工作特征曲线下面积(AUC)分别为0.870、0.770、0.860、0.890、0.870和0.910,用于预测CRT反应性。
■全局和区域心肌工作参数与CRT候选人的CRT反应相关。特别是区域心肌工作参数似乎是改善HFrEF患者CRT选择的有希望的参数。
UNASSIGNED: Previous studies have indicated that despite adhering to current patient selection guidelines, there remains a 30% to 40% subset of patients who do not experience improvement in heart failure (HF) after receiving cardiac resynchronization therapy (CRT). We aim to utilize echocardiographic myocardial work parameters to serve as predictors of responsiveness to CRT in patients with heart failure and reduced ejection fraction (HFrEF).
UNASSIGNED: We prospectively recruited patients who underwent CRT at Sun Yat-sen Memorial Hospital from June 2019 to September 2022. Comprehensive preoperative information, clinical laboratory data, conventional echocardiographic parameters and myocardial work were collected for all participants, as well as follow-up data 6 months after CRT.
UNASSIGNED: Twenty-five patients (67.6%) showed response to CRT treatment, while twelve patients (32.4%) had no response. Compared with the non-response group, the response group had larger region constructive work [RCW: the sum of constructive work (CW) in the 9 segments of the basal, mid, and apical segments of the anterior, lateral, and posterior walls], region wasted work [RWW: the sum of wasted work (WW) in the 6 segments of the basal and mid segments of the anterior septum, posterior septum and anterior walls], and the combination of RCW and RWW (RCW + RWW) in baseline (RCW: 9,695.68±2,955.40 vs. 5,219.50±2,207.68 mmHg%, P<0.001; RWW: 3,612.08±1,723.80 vs. 1,674.33±995.23 mmHg%, P=0.001; RCW + RWW: 13,307.76±3,857.71 vs. 6,893.83±2,592.83 mmHg%, P<0.001). Furthermore, global constructive work (GCW), global wasted work (GWW), GCW + GWW, RCW, RWW, and RCW + RWW had areas under the receiver operating characteristic curve (AUCs) of 0.870, 0.770, 0.860, 0.890, 0.870, and 0.910, respectively, for predicting CRT responsiveness.
UNASSIGNED: The global and regional myocardial work parameters are associated with CRT response in CRT candidates. Particularly regional myocardial work parameters appear to be promising parameters to improve selection for CRT of patients with HFrEF.