CRT是否還有進步空間來自Mayo醫(yī)院的經(jīng)驗英文幻燈課件

1、Cumuulative patientsResults presentedCumulative Enrollment in CRT Randomized TrialsPATH CHFMUSTIC SRMUSTIC AFMIRACLECONTAK CDMIRACLE ICDPATH CHF IICOMPANIONMIRACLE ICD IICARE HFCP1172680-4第1頁，共32頁。CRTReverse myocardial remodelingImprove quality of lifeImprove NYHA classReduce hospitalizations for he

2、art failureImprove survivalCRT works in 50-70% of patients第2頁，共32頁。Why not every patient response to CRTQRS morphology and durationUpgrade vs de novo implantationEtiology of cardiomyopathySinus rhythm vs atrial fibrillationReversibility of LV myocardiumLV lead positionPercentage of biventricular pac

3、ingDevice programming第3頁，共32頁。CP1305043-5Pre-CRT QRS MorphologiesN=502LBBB50%(254)Paced LBBB25%(124)RBBB7%(37)IVCD11%(53)120 ms7%(34)Dyssynchrony (9)New pacing indication/HF (14)RV-pacing induced HF (3)Advanced HF/borderline QRS (8)Chronic AF 30%第4頁，共32頁。CP1305043-12Improvement in NYHA Class After C

4、RT*Significant difference (P0.05) compared to LBBB as a reference group*Significant difference (P0.001) compared to LBBB as a reference groupImprovement in NYHA class*n=254n=37n=124n=53n=34第5頁，共32頁。CP1305043-13Improvement in LVEF (%)*n=254n=37n=124n=53n=34*Significant difference (P0.05) compared to

5、LBBB as a reference group*Significant difference (P0.001) compared to LBBB as a reference groupImprovement in LVEF After CRT第6頁，共32頁。CP1305043-16Survival After CRT Based on QRS MorphologySurvival estimate (%)YearsNo. at riskLBBB2542081498147Paced12487533721RBBB37291873IVCD534026112120 ms34231683LBBB

6、 (n=254, deaths=58)Paced LBBB (n=124, deaths=30)RBBB (n=37, deaths=14)IVCD (n=53, deaths=14)120 ms (n=34, deaths=9)P=0.039第7頁，共32頁。Fantoni C, JCE 2005第8頁，共32頁。Fantoni C, JCE 2005第9頁，共32頁。NYHA Class Pre- and Post-CRTCP1306982-9*P0.05 or *P0.001 compared to pre-CRTNYHA class*De novon=254Upgraden=125Pr

7、ePost第10頁，共32頁。LV Systolic Function: Pre- and Post-CRTCP1306982-10*P0.05 or *P0.001 compared to pre-CRTEjection fraction (%)*De novon=239Upgraden=121PrePost第11頁，共32頁。Survival After CRTDe Novo vs Upgrade groupsCP1306982-16Survival after CRT (%)63%YearsDe novo3382721899749Upgrade167118 765029De novoP=

8、0.9161%Upgrade第12頁，共32頁。CP1305043-5Pre-CRT Atrial RhythmN=502sinus66%AF34%第13頁，共32頁。Improvement in NYHA Class After CRT第14頁，共32頁。Improvement in LVEF After CRT第15頁，共32頁。Kaplan-Meier estimateSRP=0.7833025418310959172134 81 3819CP1337866-1AFYears第16頁，共32頁。Kaplan-Meier estimateYearsP=0.0081209051197 524

9、026158CP1337866-3-AVN-ABL+AVN-ABLB第17頁，共32頁。Change in LV End-Systolic Volume After CRTCP1299428-3Left ventricular end-systolicvolume change (%)MonthsBaseline612243648SR, V pacing 98%AF, AVN ablation,V pacing 100%AF, no AVN ablation,V pacing 88%第18頁，共32頁。Comparison of changes after CRT in patients wi

10、th DCM and ICMDCM(N=191)ICM (N=314) P valueChange in NYHA Class -0.7 0.8-0.6 0.80.169Change in LVEF %8.2 10.46.1 10.00.058 Change in LVEDV cc-28.4 53.2-15.2 45.70.022 第19頁，共32頁。Survivals in dilated and ischemic cardiomyopathy第20頁，共32頁。Comparison of Changes After CRTCP1306982-8 Biv pacing Biv pacing9

11、9-100% 99%Characteristicn=168n=138PNYHA class-0.80.8-0.60.80.015LV ejection fraction (%)8.510.85.28.80.006LV end-diastolic volume (mL)-27.253.4-9.541.80.006LV end-systolic volume (mL)-33.545.9-12.343.70.013Mitral regurgitation* -0.30.7 -0.10.60.081RV systolic pressure (mm Hg) -5.813.6 -4.512.60.466第

12、21頁，共32頁。Biventricular Pacing Percentage in All PatientsKoplan BA: JACC, 2009Patients (no.)Pacing (%)第22頁，共32頁。Survival Free from Heart Failure Hospitalization and All-Cause MortalityEvent-free probabilityMonths post implant1st quartile: 0-92% (n=467)2nd quartile: 93-97% (n=474), P=0.0013 (vs Q1)3rd quartile: 98-99% (n=509), P=0.0004 (vs Q1)4th quartile: 100% (n=362), P 75% of patients.The median improvements in stroke volume when sequential biventricular pa