植入术后心电图预测心脏再同步化治疗疗效的研究

摘要

[Objective]To investigate whether the presence or absence of RV1SI predicts heart failure outcomes within 1 year of cardiac resynchronization therapy (CRT) implant.[Methods]Two independent physicians reviewed the paced electrocardiogram (ECG) of 213 patients with post-CRT device implantation; when disputes occurred, it was resolved by a third reviewer. The primary end points of all-cause death, unplanned hospitalization, left ventricular assist device implant, or transplant within a 1-year follow-up were blindly adjudicated according to standard definitions. Groups were compared via Kaplan-Meier estimates and Cox proportional hazards models were used to determine the association with event-free survival.[Results]Among CRT patients postimplantation, 56 (26.3％) exhibited the RV1SI pattern on ECG. Patients with the RV1SI pattern were significantly less likely to achieve the primary end point as compared to patients without the RV1SI pattern (41.07％ vs 61.79％; Log Rank P =0.022). This difference was driven by a significantly lower risk for unplanned hospitalization among patients with the RV1SI pattern [hazard ratio =0.510; confidence interval (0.298, 0.876) ]. The predictive value remained after adjustment for potential confounders (P =0.004).[Conclusions]The 12-lead ECG postimplantation predicts clinical outcomes of biventricular (Bi V) pacing. Such prediction may be useful in predicting the need for alternative or advanced heart failure therapies. Further study into ECG patterns may help to prospectively guide CRT.%目的 探讨心电图RV1SI波型预测心脏再同步化治疗(CRT)植入术后1年内患者心力衰竭结局的价值.方法两名医生独立评估213例CRT植入后患者起搏心电图(ECG);当出现争议时,由第3位医生帮助决定.分析1年内全因死亡、非计划入院、左心室辅助装置植入和心脏移植的主要临床终点事件.运用Kaplan-Meier进行组间比较,运用比例风险回归模型(Cox模型)研究与无心血管不良事件生存期间的关系.结果 CRT植入后,56例患者ECG出现RV1SI;出现RV1SI波型患者与未出现RV1SI波型患者相比,发生主要终点事件的可能性明显减小(41.07％vs 61.79％;Log Rank检验P=0.022),这种差异是由出现RV1SI波型患者中,非计划入院风险显著降低导致[危险比=0.510;置信区间(0.298,0.876)],经过可能的混杂因素校正后,ECG RV1SI波型仍然具有预测价值(P=0.004).结论 植入后ECG能预测心脏再同步化治疗疗效,这种预测能力能够帮助预测是否需要晚期心力衰竭治疗,帮助指导CRT治疗.