Background The number of non-responders to cardiac resynchronization therapy （CRT） exposes the need for better patient selection criteria for CRT. This study aimed to identify echocardiographic parameters that would predict the response to CRT. Methods Forty-five consecutive patients receiving CRT-D implantation for heart failure （HF） were included in this prospective study. New York Heart Association （NYHA） class, 6-minute walk distance, electrograph character, and multi echocardiographic parameters, especially in strain patterns, were measured and compared before and six months after CRT in the responder and non-responder groups. Response to CRT was defined as a decrease in left ventricular end- systolic volume （LVESV） of 15% or more at 6-month follow up. Results Twenty-two （48.9%） patients demonstrated a response to CRT at 6-month follow-up. Significant improvement in NYHA class （P 〈0.01）, left ventdcular end-diastolic volume （LVEDV） （P 〈0.01）, and 6-minute walk distance （P 〈0.01） was shown in this group. Although there was an interventricular mechanical delay determined by the difference between left and right ventricular pre-ejection intervals （（42.87±19.64） ms vs. （29.43±18.19） ms, P=0.02）, the standard deviation of time to peak myocardial strain among 12 basal, mid and apical segments （Tε-SD） （（119.97±43.32） ms vs. （86.62±36.86） ms, P=0.01） and the non-ischemic etiology （P=0.03） were significantly higher in responders than non-responders, only the Tε- SD （OR=1.02, 95% CI=1.01-1.04, P=0.02） proved to be a favorable predictor of CRT response after multivariate Logistic regression analysis. Conclusion The left ventricular 12 segmental strain imaging is a promising echocardiographic parameter for predicting CRT response.
Cardiac resynchronization therapy （CRT） is an effective treatment for heart failure patients with severely obvious left ventricular ejection fraction （LVEF） and evidence of cardiac dyssynchrony.1-3 With conventional biventricular stimulation,notable left ventricular （LV） reverse remodeling,the most reliable predictor of long-term survival in CRT patients,is achieved in only 60%-70% of the patients.4,5 Lack of LV dyssynchrony,non-optimal position of the LV pacing lead,high-myocardial scar burden,and sub-optimal device programming have been related to non-response to CRT.6-8 Particularly,the optimal placement of LV lead in a tributary of the coronary sinus is one of the most challenging technique of CRT device implantation.This article will discuss the effect of ventricular leads on the clinic outcome after CRT and how to locate the optimal ventricular leads to maximize the haemodynamic benefits of CRT and provide superior longterm outcome.
患者女,58岁,因＂反复胸闷、心悸4个月,加重4d＂入大连医科大学附属第一医院.患者于2010年12月开始反复出现情绪激动时发作性胸闷、心悸,持续数分钟后缓解,并曾出现晕厥1次.动态心电图提示频发室性早搏（2495次/24 h）、室性心动过速（室速,146阵,最长持续2 min）,冠状动脉CT提示左前降支、左回旋支粥样硬化,右冠状动脉粥样硬化伴轻度狭窄.患者于2011年3月15日植入心律转复除颤器（ICD,Marquis DR 7274,美国美敦力公司）.
