心脏磁共振,电机械激活,功能和尿素在心脏再同步治疗中的升级
Derek J Bivona1, Pim J A Oomen2, Yu Wang3
1Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
Journal of cardiovascular development and disease
|October 27, 2023
概括
需要心脏再同步治疗 (CRT) 的患者与右心室节奏 (RVP) 依赖性显示出更差的生存率. 心脏磁共振 (CMR) 揭示了不同的表型,并确定慢性病是减少生存的关键因素.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 心脏衰竭研究研究
背景情况:
- 心脏再同步治疗 (CRT) 是一种治疗心力衰竭 (HF) 的方法.
- 右心室节奏 (RVP) 的依赖可能会使CRT的结果复杂化.
- 了解RVP依赖性HF的预后因素对于患者管理至关重要.
研究的目的:
- 评估心脏磁共振 (CMR) 发现和临床因素在接受CRT的有或没有RVP依赖的HF患者的预后影响.
- 在依赖RVP的HF患者中确定CRT的生存和反应的预测因子.
主要方法:
- 对接受CRT (de novo或升级) 的102名HF患者的回顾性分析.
- 临床因素和CMR发现的评估,包括左心室 (LV) 节奏部位的激活时间.
- 在RVP依赖的HF (RVP-HF) 和非RVP依赖的HF组之间的结果比较.
主要成果:
- RVP-HF患者的生存率下降 (p=0.02),更多的前面LV节拍部位 (p=0.002),较高的心房动率 (p=0.0006),以及较高的肌素 (p=0.002).
- 从CMR衍生出的LV激发部位激活时间预测了LV功能改善 (p<0.05).
- 机械激活发作<34毫秒的CMR在LV节拍部位与生存率下降有关,在RVP-HF患者中,较高的CRT前肌素部分介导了这一效应 (37%).
结论:
- 在RVP依赖的HF患者中呈现出独特的CMR表型.
- 在CRT升级过程中,CMR发现对选择LV步调站点有影响.
- 慢性病是RVP-HF患者CRT后生存率下降的重要调解者.
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