应用左室舒张末容积校正的QRS持续时间对心脏同步化治疗的预测作用

目的　探究左室舒张末容积校正的QRS持续时间（QRSd）对心脏同步化治疗的预测作用。方法 选择接受CRT的慢性心力衰竭患者79例，在手术前1个月内和术后1年分别进行了心电图、超声心动图检查QRSd和左室舒张末容积（LVEDV），对上述资料进行单因素及多因素Logistic 回归分析。结果 CRT应答组患者的QRSd/LVEDV显著高于CRT无应答组（0.73±0.27ms/ml vs 0.58±0.21 ms/ml，P=0.043）；而两组患者的QRSd和LVEDV无统计学差异。合并LBBB的患者，QRSd/LVEDV与心功能变化显著相关（R=0.469，P=0.032），而在非LBBB患者中，目的　探究左室舒张末容积校正的QRS持续时间（QRSd）对心脏同步化治疗的预测作用。方法 选择接受CRT的慢性心力衰竭患者79例，在手术前1个月内和术后1年分别进行了心电图、超声心动图检查，测定QRSd和左室舒张末容积（LVEDV）。应用单因素及多因素Logistic 回归分析对上述资料进行统计。结果 CRT应答组患者的QRSd/LVEDV显著高于CRT无应答组（0.73±0.27ms/ml vs 0.58±0.21 ms/ml，P=0.043）；而两组患者的QRSd和LVEDV无统计学差异。合并左束支传导阻滞（LBBB）的患者，QRSd/LVEDV与心功能变化显著相关（R=0.469，P=0.032），而在非LBBB患者中，QRSd/LVEDV与心功能变化无显著相关。ROC曲线分析显示QRSd/LVEDV是CRT应答的重要预测因子（AUC = 0.79; P = 0.006）；多因素回归分析显示，QRSd/LVEDV、LBBB和非缺血性心肌病是CRT应答的独立预测因子。结论 校正左室舒张末容积后的QRSd（QRSd/LVEDV）是心衰患者CRT术后应答的独立预测因子。     

超声心动图对心脏再同步化治疗慢性心力衰竭的临床应用价值

目的分析超声心动图对心脏再同步化治疗(CRT)慢性心力衰竭的临床价值。方法收集于我院就诊的临床诊断为慢性心力衰竭且行CRT的病人76例,并对所有病人于手术前、手术后1周及手术后3个月行超声心动图检查,对CRT手术前、手术后1周及手术后3个月的左心室功能和心脏同步化指标进行分析,并对手术前后Tmvs16-SD变化率(ΔTmvs16-SD)与左室舒张末期容积减小率(ΔLVEDV)、左室收缩末期容积减小率(ΔLVESV)以及左室射血分数减小率(ΔLVEF)相关性进行分析,并将ΔLVESV≥15%定义为CRT反应,用ROC曲线分析法获取预测CRT反应的Tmvs16-SD的截断值。结果手术后1周左室收缩末容积(LVESV)值低于手术前,手术后3个月的LVESV、左室舒张末容积(LVEDV)和左室舒张末内径(LVEDD)低于手术前,左室射血分数(LVEF)高于手术前,手术后3个月的LVESV、LVEDV和LVEDD低于手术后1周,LVEF值高于手术后1周,手术后1周及手术后3个月的Tmvs16-sd/RR和Vs-T-SD值均低于手术前,差异具有统计学意义(P0.05);ΔTmvs16-SD与ΔLVEDV的相关系数r=0.71,P=0.001;ΔTmvs16-SD3.5%为预测CRT反应的敏感性指标,其灵敏度为77.4%,特异度为71.4%,ROC曲线下面积为0.744。结论 CRT可改善慢性心力衰竭病人的心功能,超声心动图可有效评价左室收缩功能和同步性,能对CRT治疗有效性进行预测。     

美托洛尔治疗慢性心力衰竭的疗效研究

目的探讨美托洛尔治疗慢性心力衰竭的临床疗效。方法回顾性分析我院2008年1月—2011年1月收治的60例慢性心力衰竭患者的临床资料,将其分为治疗组和对照组各30例,对照组给予常规方法治疗,治疗组在常规治疗的基础上给予美托洛尔治疗,通过心脏彩超测定心脏功能指标变化情况。结果经过我院精心治疗8个月后,治疗组与对照组患者比较,左心室射血分数(LVEF)上升、左心室收缩末容积(LVESV)以及左心室舒张末容积(LVEDV)下降,差异均有统计学意义(P<0.05)。结论在常规治疗慢性心力衰竭的基础上应用美托洛尔能明显提高患者临床疗效,显著改善心功能,可临床推广应用。     

QRS缩短值对心脏再同步化反应性的预测价值

目的 探讨心脏再同步化治疗(CRT)患者术前与术后QRS间期的缩短值(△QRSd)对CRT有反应性的预测价值.方法 连续入选2012年2月至2019年9月我院心脏中心收住70例成功植入CRT的心力衰竭患者.根据患者CRT术后6个月左心室收缩末容积较术前改善≥15％,分为有反应组和无反应组,比较两组患者临床资料差异,采用...     

红细胞分布宽度评价心脏再同步化治疗反应性的作用

目的观察心脏再同步化治疗(CRT)的疗效和红细胞分布宽度(RDW)与CRT反应性的关系。方法回顾性分析2007年10月至2016年3月在兰州大学第一医院心脏中心住院的患者45例,依据CRT术后是否有反应分为两组:有反应组(n=27)和无反应组(n=18)。对比分析患者术前及术后6个月随访时的临床资料,采用多因素logistic回归分析CRT反应性的相关因素。结果 CRT治疗后有反应者27例,有反应率为60%。CRT术后两组患者心功能分级间差异具有统计学意义(P0.05)。与治疗前相比,有反应组患者CRT术后的心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LNEDD)、左室舒张末容积(LVEDV)、QRS波群时限(QRSd)、6 min步行距离(6MWD)和明尼苏达生活质量问卷(MLHFQ)均得到显著改善,而无反应组患者CRT术后只有LVEF、LVEDV和QRSd得到显著改善,差异均具有统计学意义(P0.05);组间比较结果显示,CRT术后有反应组患者的心功能分级和LVEF与无反应组差异具有统计学意义(P0.05)。术前心功能分级、QRS≥150 ms、△QRSd、RDW水平和植入心脏再同步化治疗除颤器是CRT后反应性的独立相关因素(P0.05)。结论评估心功能分级、QRS波群和RDW水平是CRT前的重要内容,这对CRT术后的反应性有重要意义。     

实时三维超声心动图评价心脏再同步化治疗慢性心力衰竭的短期临床疗效

目的通过实时三维超声心动图评价心脏再同步化治疗(CRT)慢性心力衰竭的短期临床疗效。方法选取2014年1月—2018年5月在宝鸡市人民医院诊断为慢性心力衰竭且行CRT的病人48例,所有病人均采用实时三维超声心动图评价心脏再同步化治疗的疗效,观察术前和术后病人左心室功能指标、左室同步化情况和心功能变化。结果术后病人左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室舒张末期内径(LVEDD)、Tmvs16-sd/RR值和Tmvs16-Dif/RR值均较术前降低,左室射血分数(LVEF)较术前升高,术后病人每搏量(SV)、心排血量(CO)和6 min步行距离均高于术前,差异均有统计学意义(P0.05)。结论 CRT可有效改善心力衰竭病人的心功能,实时三维超声心动图能有效评价左室收缩功能,可对CRT治疗的短期疗效评估提供有效的定量信息。     

扩张型心肌病患者心外膜脂肪厚度与左心室重构的相关性

目的研究扩张型心肌病(DCM)患者心外膜脂肪厚度与左心室重构及左心室功能不全的关系。方法收集DCM患者120例(DCM组)和健康体检者76例(对照组),应用常规心脏超声测量左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、左心室收缩末容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、左心室收缩末球形指数(SIs)、左心室舒张末球形指数(SId)、LVEF、心外膜脂肪厚度等,比较2组各超声指标的关系。结果 DCM组LVESD[(53.0±9.6)mmvs(33.2±4.5)mm]、LVEDD[(68.5±9.3)mmvs(38.3±3.0)mm]、LVESV[(79.5±13.6)ml vs(42.0±10.5)ml]、LVEDV[(165.0±18.6)ml vs(98.2±14.0)ml]、LVESVI[(49.2±10.7)ml/m2 vs(30.6±9.6)ml/m2]、LVEDVI[(101.8±10.0)ml/m2 vs(61.4±9.0)ml/m2]较对照组明显增高,LVEF[(31.5±7.2)%vs(64.9±6.4)%]、SIs[(1.3±0.2)vs(2.0±0.3)]、SId[(1.3±0.2)vs(1.8±0.2)]和心外膜脂肪厚度[(4.9±1.1)mmvs(7.8±2.0)mm]较对照组明显降低(P<0.05)。DCM组心外膜脂肪厚度与LVESD、LVEDD、LVESV、LVEDV、LVEDVI、LVESVI、SIs、SId呈正相关(P<0.05)。结论 DCM患者的心外膜脂肪厚度与左心室重构明显相关,与左心室功能不全无相关性。     

卡维地洛对慢性心力衰竭患者左心功能的影响

目的观察卡维地洛对慢性充血性心力衰竭患者左心室收缩功能的影响。方法117例慢性心力衰竭患者分为卡维地洛组和对照组,用心脏超声诊断仪测量治疗前和治疗后1个月、3个月的心脏结构及功能。结果两组患者治疗1个月后左心室舒张末径、左心室舒张末容积、左心室收缩末容积,左心室射血分数与治疗前比较差异均无统计学意义(P>0.05);3个月及6个月时的上述指标与治疗前比较差异均有统计学意义(P<0.05)。结论卡维地洛可明显改善慢性心力衰竭左心室收缩功能。     

实时三维超声心动图评价冠状动脉旁路移植术前后左心室功能

目的应用实时三维超声心动图定量评价冠状动脉旁路移植术前后左心室功能。方法选择行冠状动脉旁路移植术的冠心痛患者28例(冠心病组)和同期住院的其他疾病患者18例(对照组),应用实时三维超声心动图对2组左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、LVEF、左心室最大射血速率(LVPER)、左心室最大充盈速率(LVPFR)等参数进行比较。结果与对照组比较,冠心病组患者术前LVESV、LVEDV明显升高,LVEF、LVPER、LVPFR明显降低;与术前比较,冠心病组患者术后LVESV、LVEDV明显降低,LVEF、LVPER、LVPFR明显升高(P0.05)。结论实时三维超声心动图能较准确测量左心室容积、LVEF,并评价冠状动脉旁路移植术前后左心室功能。     

基于压力-应变曲线评估心力衰竭病人整体无效做功对心脏再同步化治疗应答的预测价值

目的:采用压力-应变曲线(PSL)测定心脏整体无效做功(GWW),评估射血分数减低心力衰竭(HFrEF)病人术前GWW对心脏再同步化治疗(CRT)应答的预测价值,及其与长期不良预后的关系。方法:选取2018年1月—2019年1月在中山市中医院接受CRT治疗的50例HFrEF病人为研究对象,于术前及术后9个月测量常规超声心动图参数,并采用基于二维斑点追踪应变成像的压力-应变曲线(PSL)测定包括GWW在内的心肌做功参数,应用受试者工作特征(ROC)曲线分析术前GWW对CRT应答的预测价值,应用Cox回归分析模型分析术前GWW与CRT应答及不良事件的关系。CRT应答为从基线检查到术后9个月随访期间左心室舒张末期容积(LVEDV)缩小≥15%,有CRT应答病人列为有效组,其余为无效组。研究的终点为CRT应答或随访期间的全因死亡。结果:与术前相比,有效组术后的LVEDV、左心室舒张末期内径(LVEDD)和左心室收缩末期容积(LVESV)较术前均减小,左室射血分数(LVEF)较术前增大;有效组术后的GWW下降,整体有效做功(GCW)、整体做功指数(GWI)、整体做功效率(GWE)均增高,差异有统...     

QRS时限对心脏再同步治疗疗效的预测价值

目的探讨QRS时限（QRSd）对心脏再同步治疗（CRT）的预测价值。方法入选患者心功能Ⅲ～Ⅳ级（NYHA分级）、在心室射血分数≤0．35、超声心动图提示心室不同步患者行CRT治疗。植入术前、术后当天及术后6个月行心电图和超声心动图检查。以治疗6个月后左心室收缩末容积较术前减小的百分数（△LVESV％）≥15％作为治疗有效的标准,分析术前QRSd、术后QRSd及QRS时限缩短值（△QRSd=术前QRSd-术后QRSd）对CRT疗效的预测价值。结果（1）共入选40例患者,随访期间1例死亡,2例失访,余37例进入分析。其中,7例为窄QRS波（〈120ms）,30例为宽QRS波（≥120ms）。窄QRS波的CRT的有效率较宽QRS波,但差异无统计学意义（28．57％vs66．67％,P=0．079）;（2）宽QRS波组中,治疗有效者与无效者比,术前的左心室容积、左心室射血分数、QRSd、男女比例、心律、室内阻滞情况及△QRSd均差异无统计学意义（P〉0．05）;（3）宽QRS波组中,治疗有效者术后QRSd缩短[（151．0±23．2）ms vs（167．0±25．2）ms,P〈0．05],而无效者无变化[（166．0±19．0）msvs（168．0±42．1）ms,P〉0．05]。受试者工作特征（ROC）曲线显示术前QRSd和△QRSd均不能预测CRT的疗效（P〉0．05）;△QRSd与△LVESV％无相关性（P〉0．05）。结论窄QRS波的CRT疗效可能较宽QRS波差。虽然QRSd缩短仅见于CRT有效,但术前QRSd和△QRSd均不足以预测宽QRS波的CRT疗效。     

心力衰竭患者心脏再同步化疗效的多因素分析

目的：探讨影响心力衰竭患者心脏再同步化治疗（CRT）效果的因素. 方法：入选因慢性心功能不全接受CRT的患者25例.CRT应答定义为术后6个月左室收缩末期容积（LVESV）减少＞15％以及纽约心功能改善1级以上（包括1级）,不达上述标准以及因心力衰竭死亡者定义为CRT无应答.对所有患者随访（26.0±15.9）个月,17例表现为CRT应答,8例表现为CRT无应答,分析两组患者的临床基线特征及治疗前后心功能分级、基线QRS波时限（QRSd）等指标,并作logistic回归分析. 结果：慢性心力衰竭患者对CRT的反应与QRSd（r=1.19,P=0.01）、术后QRSd缩短时间（ΔQRSd,r=1.28,P=0.01）相关.ROC曲线分析显示,基线QRSd＞135 ms预测CRT应答的敏感性为70.6％0、特异性为62.5％,ΔQRSd缩短25 ms预测CRT应答的敏感性为64.7％、特异性为90.9％. 结论：QRS波基线值和ΔQRSd是CRT应答的预测因子.     

心脏再同步治疗术后QRS时限变化对长期疗效的影响

目的：通过分析植入心脏再同步治疗（ CRT）术后QRS时限（ QRSd）的变化,评估术后不同的QRSd对CRT长期预后的影响。方法2001年4月至2012年3月来自沈阳军区总医院及白求恩国际和平医院住院并植入CRT的心力衰竭患者164例,按术后QRSd变化分为3组：Ⅰ组：107例（ QRSd术前〉术后）,Ⅱ组：30例（ QRSd术前〈术后）,Ⅲ组：27例（ QRSd术前=术后）。观察术后3组病死率及心功能指标变化。结果随访48个月,3组患者的病死率及死因差异无统计学意义（ P〉0．05）。Ⅰ组和Ⅲ组术后心功能及左心室射血分数（LVEF）较Ⅱ组明显改善（P〈0．05-0．01）,且左心室舒张末期内径（ LVEDD）明显缩小（ P〈0．05-0．01）。Ⅱ组术后心功能及 LVEF也明显改善（ P〈0．05-0．01）,但LVEDD无明显缩小（P〉0．05）。术后QRSd较术前变宽或变窄与术前QRSd的基础值有关,术前QRSd〈140 ms是术后QRSd变宽的影响因素。结论术后QRSd变化对预后影响不同,QRSd变窄患者不但临床心功能恢复的较好,而且还可有明显的左心室逆重构,更奠定了长期心功能改善的基础。术后QRSd变化与术前QRSd有明显关系,术前QRSd〈140 ms时,术后QRSd变窄的几率小,因此,术前QRSd越宽,术后QRSd变窄的效果越好。     

Novel electrocardiographic dyssynchrony criteria that may improve patient selection for cardiac resynchronization therapy

Cardiac resynchronization therapy(CRT)is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction refractory to optimal medical treatment associated with intraventricular conduction disturbance,that results in electrical dyssynchrony and further deterioration of systolic ventricular function.However,the non-response rate to CRT is still 20%?40%,which can be decreased by better patient selection.The main determinant of CRT outcome is the presence or absence of significant ventricular dyssynchrony and the ability of the applied CRT technique to eliminate it.The current guidelines recommend the determination of QRS morphology and QRS duration and the measurement of left ventricular ejection fraction for patient selection for CRT.However,QRS morphology and QRS duration are not perfect indicators of electrical dyssynchrony,which is the cause of the not negligible non-response rate to CRT and the missed CRT implantation in a significant number of patients who have the appropriate substrate for CRT.Using imaging modalities,many ventricular dyssynchrony criteria were devised for the detection of mechanical dyssynchrony,but their utility in patient selection for CRT is not yet proven,therefore their use is not recommended for this purpose.Moreover,CRT can eliminate only mechanical dyssynchrony due to underlying electrical dyssynchrony,for this reason ECG has a greater role in the detection of ventricular dyssynchrony than imaging modalities.To improve assessment of electrical dyssynchrony,we devised two novel ECG dyssynchrony criteria,which can estimate interventricular and left ventricular intraventricular dyssynchrony in order to improve patient selection for CRT.Here we discuss the results achieved by the application of these new ECG dyssynchrony criteria,which proved to be useful in predicting the CRT response in patients with nonspecific intraventricular conduction disturbance pattern(the second greatest group of CRT candidates),and the significance of other new ECG dyssynchrony criteria in the potential improvement of CRT outcome.     

Baseline Doppler parameters are useful predictors of chronic left ventricular reduction in size by cardiac resynchronization therapy.

AIMS: The identification of responders to cardiac resynchronization therapy (CRT) in patients with left ventricular (LV) dysfunction and left bundle branch block (LBBB) remains difficult. We aimed to define the predictive value of conventional Doppler parameters. METHODS AND RESULTS: In 73 patients (65 +/- 9 years, 51 male, 36 ischaemic, 37 non-ischaemic cardiomyopathy, QRS 167 +/- 31 ms, LVEF 23 +/- 6%) with LBBB, a CRT device was implanted. LV pre-ejection interval (PEI), interventricular mechanical delay (IVMD), LV filling time (FT), and myocardial performance index (MPI) were assessed at baseline and on optimized CRT. Left ventricular end-diastolic diameter (EDD) was obtained at baseline and after 10.6 +/- 6.7 months. end-diastolic diameter diminished from 66.3 +/- 8.1 to 59.9 +/- 9.6 mm (P < 0.001). Initial LVPEI (r = 0.41, P < 0.001), baseline IVMD (r = 0.34, P = 0.003), acute LVPEI shortening (r = 0.33, P = 0.006), and baseline LVEDD (r = 0.32, P = 0.007) correlated with LVEDD reduction. An LVPEI > or =140 ms had a 82% accuracy to predict long-term LVEDD reduction (sensitivity 86%, specificity 67%, positive and negative predictive values 91 and 56%, respectively). Multivariate analysis solely revealed baseline LVPEI as predictor of LVEDD reduction. FT and MPI correlated only with their respective improvements. CONCLUSION: Left ventricular pre-ejection interval and IVMD predict favourable LV remodelling on CRT. The additional application of tissue Doppler parameters may further increase specificity and negative predictive value.     

Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony

OBJECTIVES: The value of interventricular and intraventricular echocardiographic asynchrony parameters in predicting reverse remodeling after cardiac resynchronization therapy (CRT) was investigated. BACKGROUND: Cardiac resynchronization therapy has been suggested as a promising strategy in patients with severe heart failure and left bundle branch block (LBBB), but the entity of benefit is variable and no criteria are yet available to predict which patients will gain. METHODS: Interventricular and intraventricular mechanical asynchrony was evaluated in 20 patients (8 men and 12 women, 63 +/- 10 years) with advanced heart failure caused by ischemic (n = 4) or nonischemic dilated cardiomyopathy (n = 16) and LBBB (QRS duration of at least 140 ms) using echocardiographic Doppler measurements. Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were calculated before and one month after CRT. Patients with a LVESVI reduction of at least 15% were considered as responders. RESULTS: Cardiac resynchronization therapy significantly improved ventricular volumes (LVEDVI from 150 +/- 53 ml/m(2) to 119 +/- 37 ml/m(2), p < 0.001; LVESVI from 116 +/- 43 ml/m(2) to 85 +/- 29 ml/m(2), p < 0.0001). At baseline, the responders had a significantly longer septal-to-posterior wall motion delay (SPWMD), a left intraventricular asynchrony parameter; only QRS duration and SPWMD significantly correlated with a reduction in LVESVI (r = -0.54, p < 0.05 and r = -0.70, p < 0.001, respectively), but the accuracy of SPWMD in predicting reverse remodeling was greater than that of the QRS duration (85% vs. 65%). CONCLUSIONS: In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.     

心脏再同步治疗对慢性心衰患者心功能、心律失常、运动能力及生活质量的影响

目的:观察心脏再同步治疗对慢性心力衰竭(CHF)患者心功能、心律失常、运动能力及生活质量的影响。方法:选择本院行心脏再同步治疗的95例CHF患者临床资料,观察治疗前、治疗12周后心功能、心律失常指标、运动能力变化,并采用明尼苏达心力衰竭生活质量调查问卷(MLHFQ)评估患者治疗前后的生活质量。结果:与术前比较,术后12周患者左室收缩末期容积(LVESV)[(138.90±25.28)ml比(119.87±20.78)ml]、二尖瓣返流面积(MRA)[(5.36±0.95)cm^2比(2.66±0.77)cm^2]、MRA/左房面积(LAA)[(30.87±8.48)比(20.03±5.61)]、各左室壁12节段的收缩达峰时间(TS)间的极差(Ts-maxD)[(112.44±15.1)ms比(62.82±13.23)ms]、各TS间的标准差(Ts-SD)[(22.48±5.41)ms比(14.77±2.86)ms]均显著减小(P均=0.001),左室射血分数(LVEF)[(29.44±4.12)%比(36.52±4.58)%]、左室内压最大变化速率(LVdp/dt)[(602.9±108.74)mmHg比(1325.19±188.85)mmHg]均显著提高(P均=0.001),房早、阵发房速、阵发房颤、阵发室速发生数均显著减少(P均=0.001),6min步行距离[(280.31±11.12)m比(387.46±17.01)m]显著增加(P=0.001),MLHFQ各项评分及总分[(67.59±8.29)分比(47.02±7.42)分]显著降低,生活质量显著改善(P均=0.001)。结论:心脏再同步治疗能够显著改善慢性心衰患者的左室收缩功能,减少房性心律失常、阵发室速的发生风险,提高患者活动能力与生活质量。     

Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy

OBJECTIVES: The aim of this study was to evaluate whether the clinical benefit of cardiac resynchronization therapy (CRT) can be prospectively predicted by means of the baseline evaluation of left ventricular asynchrony. BACKGROUND: The reverse remodeling associated with CRT is more evident in patients with severe heart failure (HF) and left bundle branch block (LBBB) who have left ventricular asynchrony. METHODS: Baseline left ventricular asynchrony was assessed in 60 patients with severe HF and LBBB by calculating the electrocardiographic duration of QRS and the echocardiographic septal-to-posterior wall motion delay (SPWMD). Left ventricular size and left ventricular ejection fraction (LVEF), mitral valve regurgitation, and functional capacity were also evaluated. The progression toward HF (defined as a worsening clinical condition leading to a sustained increase in conventional therapies, hospitalization, cardiac transplantation, and death) was assessed during follow-up, as were the changes in LVEF after six months. RESULTS: During the median follow-up of 14 months, 16 patients experienced HF progression. Univariate analysis showed that ischemic cardiomyopathy, changes in the QRS duration after implantation, and SPWMD significantly correlated with events. At multivariate analysis, a long SPWMD remained significantly associated with a reduced risk of HF progression (hazard ratio: 0.91; 95% confidence interval: 0.83 to 0.99; p <0.05). An improvement in LVEF was observed in 79% of the patients with a baseline SPWMD of > or =130 ms and in 9% of those with an SPWMD of <130 ms (p <0.0001). CONCLUSIONS: Baseline SPWMD is a strong predictor of long-term clinical improvement after CRT in patients with severe HF and LBBB.     

Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology

Patients with non-left bundle branch block (LBBB) morphologies are thought to derive less benefit from cardiac resynchronization therapy (CRT) than those with LBBB. However, some patients do exhibit improvement. The characteristics associated with a response to CRT in patients with non-LBBB morphologies are unknown. Clinical, electrocardiographic, and echocardiographic data were collected from 850 consecutive patients presenting for a new CRT device. For inclusion, all patients had a left ventricular ejection fraction of ≤35%, a QRS duration of ≥120 ms, and baseline and follow-up echocardiograms available. Patients with a paced rhythm or LBBB were excluded. The response was defined as an absolute decrease in left ventricular end-systolic volume of ≥10% from baseline. Multivariate models were constructed to identify variables significantly associated with the response and long-term outcomes. A total of 99 patients met the inclusion criteria. Of these 99 patients, 22 had right bundle branch block and 77 had nonspecific intraventricular conduction delay; 52.5% met the criteria for response. On multivariate analysis, the QRS duration was the only variable significantly associated with the response (odds ratio per 10-ms increase 1.23, 95% confidence interval 1.01 to 1.52, p = 0.048). During a mean follow-up of 5.4 ± 0.9 years, 65 patients died or underwent heart transplant or left ventricular assist device placement. On multivariate analysis, the QRS duration was inversely associated with poor long-term outcomes (hazard ratio per 10-ms increase 0.79, 95% confidence interval 0.66 to 0.94, p = 0.005). In patients with advanced heart failure and non-LBBB morphologies, a wider baseline QRS duration is an important determinant of enhanced reverse ventricular remodeling and improved long-term outcomes after CRT.