对CRT反应预测器 (PROSPECT) 试验的结果
Eugene S Chung1, Angel R Leon, Luigi Tavazzi
1Lindner Clinical Trial Center, Cincinnati, OH 45219, USA. chunge@ohioheart.org
Circulation
|May 7, 2008
概括
在一项大型多中心研究中,对机械失同的心声测量显示,预测患者对心脏再同步治疗 (CRT) 的反应的能力有限. 需要进一步的研究来减少变化,并提高这些参数的预测能力.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 心脏衰竭管理的管理
背景情况:
- 单中心研究表明,机械失同的回声心脏学参数可以改善心脏再同步治疗 (CRT) 的患者选择.
- 对CRT反应的预测者 (PROSPECT) 研究旨在在多中心环境中前性评估这些参数.
研究的目的:
- 测试机械异步的回声心脏学参数在预测CRT响应中的性能.
- 评估这些参数的实用性,超出目前的患者选择准则.
主要方法:
- 一项前性多中心试验招募了498名具有标准CRT指示的患者.
- 使用传统和组织多普勒方法评估了12个心声回声失调参数.
- 患者对CRT的反应是由临床综合评分和6个月后左心室末缩体积的改善来定义的.
主要成果:
- 69%的患者的临床综合评分有所改善,56%的患者的左心室末缩体积下降了>=15%.
- 12个心声回声学参数的预测能力差异很大,灵敏度和特异性较低.
- 预测CRT响应的接收机操作特征曲线下的面积为所有参数<=0.62,表明预测能力适度.
结论:
- 无法推单个心声回声测量异步,以改善超出当前指导方针的CRT患者选择.
- 在参数分析中观察到显著的变化,尽管有培训和中央审查.
- 减少技术和解释性的变化对于提高临床实践中心声学参数的预测值至关重要.
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