左室电延迟对心脏再同步化治疗超反应性的价值

The value of left ventricular electrical delay on cardiac resynchronization therapy super-response

目的探讨左室电延迟(体表心电图QRS波起始到左室电极感知波最高峰之间的时间间距,QLV)对心脏再同步化治疗(CRT)超反应的价值。方法入选2014年12月至2021年2月在中山大学孙逸仙纪念医院植入带有SmartDelay功能CRT的患者42例,以QLV的中位数将患者分为窄QLV和宽QLV两组,以术后6个月左室收缩末容积缩小≥30%定义为CRT超反应,比较两组患者CRT超反应率和预后的差异,用Logistics回归寻找CRT超反应的影响因素。结果两组患者CRT术后6个月左房左室均较术前明显缩小(P<0.01);与窄QLV组(n=21)比较,宽QLV组(n=21)患者超反应率高(85.7%vs 52.4%,P=0.045),心力衰竭再入院率低(9.5%vs 47.6%,P=0.017)。Logistics回归分析显示QLV是CRT超反应独立的影响因素(OR=1.028,P=0.025)。结论QLV是CRT超反应独立的影响因素,QLV宽者CRT疗效和预后较好。

Objective To explore the value of left ventricular electrical delay(the time from the onset of QRS complex to the first sharp peak in LV electrogram,QLV)in predicting cardiac resynchronization therapy(CRT)super-response.Methods A total of 42 patients implanted with CRT with SmartDelay were enrolled at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from December 2014 to February 2021.Patients were divided into narrow QLV group and wide QLV group based on the median of measured QLV.CRT super-response was defined prospectively as a≥30%reduction in left ventricular end systolic volume from implant to 6 months.The difference in CRT super-response rate between two groups was compared,and multivariable logistic regression was used to determine the potential relative factors on CRT super-response.Results Significant reduction in left atrial dimensions and left ventricular dimensions were seen in both groups 6 months after the procedure(both P<0.01).Compared with the narrow QLV group(n=21),the wide QLV group(n=21)had a higher CRT super-response rate(85.7%vs 52.4%,P=0.045)and a lower heart failure hospitalization occurrence(9.5%vs 47.6%,P=0.017).Logistics regression analysis showed that QLV was an independent predictor of CRT super-response(OR=1.028,P=0.025).Conclusion QLV is an independent factor affecting CRT super-response.Patients with wide QLV have better CRT efficacy and prognosis.