类本位曲折对心脏再同步化治疗后反应性的预测价值

Predictive value of intrinsicoid deflection in reactivity after cardiac resynchronization therapy

目的:探讨代表心室激动时间延迟的类本位曲折间期对心脏再同步化治疗(CRT)反应性的预测价值。方法:连续入选兰州大学第一医院心脏中心2009年12月至2018年2月收治的71例成功植入CRT的心力衰竭患者,收集患者基线资料、体表心电图及超声心动图指标。根据患者术后6个月左室收缩末期容积较术前降低≥15%,将患者分为CRT有反应组(n=47)和CRT无反应组(n=24),比较两组患者临床资料,采用logistic回归分析类本位曲折间期对CRT反应性的预测价值,通过受试者工作特征(ROC)曲线判断预测CRT有反应的最佳截断值截。结果:成功植入CRT的慢性心力衰竭患者中男性居多,扩张性心肌病是最常见的病因。CRT有反应组QRS缩短值(ΔQRSd)、术前及术后6个月射血分数的改变值(ΔLVEF)、术前V 5导联类本位曲折间期(ID V5)和V 6导联类本位曲折间期(ID V6)均大于CRT无反应组,差异有统计学意义(P均<0.05)。Logistic回归分析发现ΔLVEF(OR=1.07,95%CI:1.01~1.13,P=0.02)、ΔQRSd(OR=1.13,95%CI:1.07~1.19,P均<0.01)、术前ID V5(OR=1.11,95%CI:1.05~1.18,P均<0.01)和ID V6(OR=1.04,95%CI:1.01~1.07,P均<0.01)与CRT反应有相关性。ROC曲线示当ID V5为71 ms时,约登指数最大为0.390,ROC曲线下面积为0.791(95%CI:0.685~0.900,P均<0.01);当ID V6为79 ms时,约登指数最大为0.459,ROC曲线下面积为0.740(95%CI:0.599~0.880,P均<0.01)。结论:左室侧壁类本位曲折间期对CRT反应性具有预测价值,结合ΔQRSd值可进一步提高对CRT反应性的预测价值。

Objective:To explore the value of intrinsicoid deflection(ID)time,which represents delayed ventricular activation,in predicting response to cardiac resynchronization therapy(CRT).Methods:A total of 71 consecutive patients with chronic heart failure receiving CRT in the First Hospital of Lanzhou University from December 2009 to February 2018 were included.Baseline data,surface electrocardiogram and echocardiography paraments of all the patients were collected.According to the changes of left ventricular end systolic volume(LVESV)at 6 months after operation,the patients were divided into two groups,namely response group(n=47),in which LVESV decreased 15%and above,and non-response group(n=24).The clinical characteristics of the two groups were compared.Logistic regression analysis was used to reveal whether ID time had predictive value for CRT response or not,and the best cutoff point for predicting response was judged by receiver operating characteristic(ROC)curve.Results:Most of the patients with CRT implantation was male,and dilated cardiomyopathy was the most common cause.Compared with the non-response group,the preoperative ID time in lead V 5(ID V5)and V 6(ID V6)in response group was longer,with more QRS decrease(ΔQRSd)and changes of ejection fraction(ΔLVEF)before and 6 months after operation(all P<0.05).Logistic regression analysis showed thatΔLVEF(OR=1.07,95%CI 1.01-1.13,P=0.02),ΔQRSd(OR=1.13,95%CI 1.07-1.19,P<0.01),ID V5(OR=1.11,95%CI 1.05-1.08,P<0.01)and ID V6(OR=1.04,95%CI 1.01-1.07,P<0.01)were correlated to CRT response.Accoreding to ROC curve,when ID V5 was 71 ms the Youden index was the largest(0.390)and the area under the ROC curve was 0.791(95%CI 0.685-0.900,P<0.01).When ID V6 was 79 ms the Youden index was the largest(0.459)and the area under the ROC curve was 0.740(95%CI 0.599-0.880,P<0.01).Conclusions:The ID time has good predictive value for CRT response.Combining withΔQRSd value can improve the predictive accuracy.