Analysis Of Reactivity And Prognostic Factors Related To Cardiac Resynchronization Therapy In Patients With Heart Failure

Objective To analyze retrospectively the clinical cases undergone cardiac resynchronization therapy(CRT)in our hospital in recent 16 years,and compare the clinical characteristics in patients with different responses to CRT to define factors related to the efficacy and prognosis of CRT.Methods Collect the clinical data of 72 patients presenting for CRT-P/D(pacing/defibrillation)at Fujian Provincial Hospital from February,2013 to February,2018.All patients were divided,according to the echocardiographic information,into non-response group,response group and super-response group.The difference in clinical materials and outcomes was analyzed in 3 groups.Results 1.Of the 72 patients,there are 23(31.9%)females and 49(68.1%)males;22 non-responders,19 responders and 31 super-responders.The patients were followed-up at 3 to 66 months(median 13.5 months)after CRT.2.Univariate analysis indicated that,comparing the three groups,the percentage of patients with per-CRT QRS duration ?150ms(67.7%)and femals(48.4%)was higher in super-response group;the percentage of patients(89.5%)with non-ischemic cardiomyopathy(NICM)was higher in response group;the percentage of patients with atrial fibrillation or atrial flutter(54.5%)and patients with ventriculer arrhythmia(63.6%)was higher in non-response group.No significant differences were noted in terms of left bundle branch block(LBBB)between the three groups,but LBBB patients had the higher ratio(61.3%)in super-response group.multivariate Logistic regression analysis showed that female gender,QRS duration ?150ms and LVEDV was an independent determinant for CRT response.3.Analysis about the follow-up materials shows that,the NYHA grading was obviously improved after CRT in all three groups(P < 0.05).The indexes of left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDD),left ventricular end-diastolic volume(LVEDV)and the severity of mitral regurgitation grading were significantly improved in super-response group after CRT(all P<0.05).In response group,only LVEF was improved(P<0.05),and other indexes had no significant changes.In non-response group,the severity of mitral regurgitation grading was improved,but the LVEF was significantly reduced(P<0.05),and other indexes had no significant changes.4.Overall,There were 23 patients died or hospitalized again for HF,the all-cause death occurred in 6.9%(5/72).Kaplan-Meier survival analysis indicated that,event-free survival from death or rehospitalization was significantly longer in patients with QRS duration ?150ms,super-response to CRT and mild to moderate renal insufficiency(P<0.05).Conclusion 1.Female gender and wider QRS duration(QRS?150ms)were independently associated with super-response,LVEDV is weak in agrument.2.NICM and LBBB may be relate to CRT response.3.Atrial fibrillation or atrial flutter and ventriculer arrhythmia had more chance to suffer form non-response after CRT.4.QRS duration ?150ms,super-response to CRT and mild to moderate renal insufficiency was associated with persistent excellent prognosis regarding survival compare with QRS duration <150ms,nonsuper-response to CRT and sever renal insufficiency.