基于应变的分期作为心脏再同步治疗中的统一概念
Jürgen Duchenne1,2,3,4, Simon Calle5, Ivan Stankovic6
1Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
European heart journal. Cardiovascular Imaging
|May 26, 2025
概括
左束枝分支块 (LBBB) 隔膜张力模式预测心脏再同步治疗 (CRT) 的结果. 较低的应变阶段表明益处减少,可能是由于心肌痕,突出显示个性化CRT的LBBB模式.
科学领域:
- 心脏病学 心脏病学
- 心脏电生理学 心脏电生理学
- 医疗成像医学成像
背景情况:
- 左束枝分支块 (LBBB) 隔膜张力模式与心脏再同步治疗 (CRT) 后的左心室 (LV) 反向重塑有关.
- 需要进一步调查LBBB菌株模式的预后价值及其对CRT结果的影响,包括与保守治疗的比较.
- 了解LBBB菌株模式,心肌痕和CRT反应之间的相互作用对于优化患者选择和治疗策略至关重要.
研究的目的:
- 在接受CRT的患者中验证LBBB隔膜菌株模式的预后意义.
- 调查LBBB菌株模式对CRT接受者的临床结果和体积反应的影响.
- 探索LBBB菌株模式,心肌痕负担和接受保守治疗的CRT合格患者的CRT疗法疗效之间的关系.
主要方法:
- 一项涉及267名CRT患者的多中心研究,这些患者接受了植入前斑点追踪菌株分析.
- 155名CRT患者进行了心脏磁共振成像,以评估心肌痕.
- 与116名接受CRT治疗的患者和116名接受CRT治疗的保守治疗的患者进行比较,将LBBB隔膜菌株曲线分为五个阶段 (LBBB-0至LBBB-4).
主要成果:
- 在CRT接受者中,在LBBB阶段观察到体积反应和生存的逐步改善 (分别P < 0.001和P = 0.002).
- 心肌痕,在52%的CRT患者中存在,与LBBB阶段呈反相关性 (P = 0.003).
- LBBB阶段独立地预测了体积反应 (OR 2.30,P < 0.001) 和生存率 (HR 0.64,P = 0.038),而痕负担没有. 接受CRT治疗的患者与保守治疗的患者的生存益处显著更大,特别是在较高的LBBB阶段.
结论:
- LBBB隔膜菌株阶段作为CRT结果的独立预测器.
- 较低的LBBB菌株阶段与减弱的CRT益处有关,可能由更高的心肌痕负担介导.
- 这种LBBB菌株分类为了解LBBB病理生理学和优化CRT反应提供了有价值的框架.
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