识别非左束分支区块中对心脏再同步治疗没有反应的患者
Toshihiro Nakamura1, Kohei Ishibashi2, Nobuhiko Useda1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
概括
电心电图带动的心肌 perfusion 单光子发射计算机断层扫描成像 (G-MPI SPECT) 可以预测没有左束分支阻塞 (LBBB) 的患者对心脏再同步治疗 (CRT) 的不响应. 带宽和相位标准偏差的最佳切断值可以识别潜在的不响应者,改善患者管理.
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:
- 对心脏再同步疗法 (CRT) 的不响应是心力衰竭的重要挑战,尤其是那些没有左束分支块 (LBBB) 的患者.
- 电心电图带动的心肌 perfusion 单光子发射计算机断层扫描 (G-MPI SPECT) 是评估左心室 (LV) 不同步的关键成像方式.
- 预测CRT反应对于优化治疗策略和改善HFrEF患者的治疗结果至关重要.
研究的目的:
- 为了研究G-MPI参数与LBBB和没有LBBB的患者中CRT不响应之间的关联.
- 确定特定的G-MPI指标,可以预测非LBBB人群中CRT不响应.
- 增强患者对CRT的选择,并提高治疗疗效.
主要方法:
- 分析了一组128名在2021年1月至2022年12月期间接受CRT的患者.
- 选择了73名手术前G-MPI评估的患者,包括43名非LBBB患者和30名LBBB患者.
- 进行了接收器操作特征 (ROC) 曲线和多变量分析,以确定CRT无响应的预测因素.
主要成果:
- 在非LBBB患者中,G-MPI带宽 (108°) 和相位标准偏差 (27.7°) 的最佳切线值预测了CRT不响应 (AUC分别为0.762和0.742).
- 带宽≥108°和阶段SD≥27.7°被确定为非LBBB组中CRT不响应的独立预测因素 (HR5.65,P=0.009).
- 在LBBB患者中,G-MPI参数和CRT不响应之间没有发现显著的关联.
结论:
- 手术前的G-MPI参数,特别是带宽和相位标准偏差,与非LBBB患者的CRT不响应有关.
- 这些发现表明,G-MPI可以在治疗前帮助识别潜在的CRT不响应患者.
- 更好地识别非响应者可以导致更好的患者选择和CRT的管理策略.
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