Predictors of non-response to cardiac resynchronization therapy implantation in patients with class Ⅰ indications: the markedly dilated left ventricular end-diastolic dimension and the presence of fragmented QRS  

作　　者：Yi-Ran HU Wei HUA Sheng-Wen YANG Min GU Hong-Xia NIU Li-Gang DING Jing WANG Ran JING Xiao-Han FAN Shu ZHANG 

机构地区：[1]State Key Laboratory of Cardiovascular Disease,Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China

出　　处：《Journal of Geriatric Cardiology》2019年第7期514-521,共8页老年心脏病学杂志（英文版）

基　　金：financially supported by the National Natural Science Foundation of China(81570370);CAMS Innovation Fund for Medical Sciences(2017-I2M-1-009)

摘　　要：Background Cardiac resynchronization therapy(CRT)is a highly effective treatment in patients with a class I recommendation.However,a small proportion of the strictly selected patients still fail to respond.This study was designed to identify predictors of non-response in patients with class I indications for CRT and determine the non-response probability of the patients.Methods A total of 296 consecutive patients with a class I recommendation received CRT from January 2009 to January 2017 were retrospectively analyzed.Multivariate logistic regression analysis was performed to identify predictors for non-response(defined as cardiac death,heart transplantation,or HF hospitalization during 1-year follow-up).Results Among 296 patients,30(10.1%)met non-response.Multivariate analysis demonstrated that non-response to CRT was associated with a fragmented QRS(odd ratio(OR)=2.86,95%CI:1.14–7.12;P=0.025)and left ventricular end-diastolic dimension(LVEDD)≥77 mm(OR=3.02,95%CI:1.17–7.82;P=0.022).Patients with both of the predictors had a non-response probability of 46.2%(95%CI:19.1%–73.3%).Conclusion In patients with left bundle branch block and wider QRS duration,the proportion of non-response to CRT is not low in real world.The presence of the dilated LVEDD or fragmented QRS is a strong predictor of non-response to CRT.The probability of non-response in the patients with the two predictors was 46.2%.Background Cardiac resynchronization therapy(CRT) is a highly effective treatment in patients with a class I recommendation. However, a small proportion of the strictly selected patients still fail to respond. This study was designed to identify predictors of non-response in patients with class I indications for CRT and determine the non-response probability of the patients. Methods A total of 296 consecutive patients with a class I recommendation received CRT from January 2009 to January 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify predictors for non-response(defined as cardiac death, heart transplantation, or HF hospitalization during 1-year follow-up). Results Among 296 patients, 30(10.1%) met non-response. Multivariate analysis demonstrated that non-response to CRT was associated with a fragmented QRS(odd ratio(OR) = 2.86, 95% CI: 1.14–7.12; P = 0.025) and left ventricular end-diastolic dimension(LVEDD) ? 77 mm(OR = 3.02, 95% CI: 1.17–7.82; P = 0.022). Patients with both of the predictors had a non-response probability of 46.2%(95% CI: 19.1%–73.3%). Conclusion In patients with left bundle branch block and wider QRS duration, the proportion of non-response to CRT is not low in real world. The presence of the dilated LVEDD or fragmented QRS is a strong predictor of non-response to CRT. The probability of non-response in the patients with the two predictors was 46.2%.

关 键 词：Cardiac RESYNCHRONIZATION therapy CLASS I indication NON-RESPONSE PREDICTORS 

分 类 号：R54[医药卫生—心血管疾病]