Acute and Chronic Response to CRT in Narrow QRS Patients

作者：Donahue Tim^*; Niazi Imran; Leon Angel; Stucky Michael; Herrmann Keith

来源：Journal of Cardiovascular Translational Research, 2012, 5(2): 232-241.

DOI：10.1007/s12265-011-9338-3

• Cardiac resynchronization therapy
• Hemodynamics
• Dyssynchrony
• Heart failure
• Narrow QRS
• Echocardiography
• Acute
• Chronic

Previous studies suggest that CRT may benefit narrow QRS patients with mechanical dyssynchrony (MD). We conducted an acute and chronic study, evaluating the response of heart failure patients with a narrow QRS to cardiac resynchronization therapy (CRT). ESTEEM-CRT was a multi-center, single-arm, feasibility study that evaluated ICD-indicated, medically-optimized patients with EF <= 35%, NYHA class III heart failure, QRS duration < 120 ms, and MD as defined by the standard deviation of time to peak systolic velocity of 12 segments (Ts-SD). Sixty-eight patients received a CRT defibrillator, exercise testing, and echo exams, and 47 of these patients underwent invasive hemodynamic testing at implant. Follow-up was at 6 and 12 months. The average maximal improvement in LV dP/dt(max) was minor (2 +/- 2%). NYHA and quality of life scores were substantially improved at 6 and 12 months (P < 0.001), while exercise capacity and LV volumes were unchanged. The echo indices of MD were difficult to collect, discordant, and failed to predict clinical outcomes. ESTEEM-CRT patients with a narrow QRS and MD as defined in this study did not improve as measured by acute hemodynamics, chronic exercise performance, or reverse remodeling. These multi-center results support the notion that dyssynchrony indices are ineffective or at least require greater refinement for the selection of narrow QRS patients for CRT.

• 出版日期2012-4