运用心发肺运动试验评价起搏器疗效.pptVIP

RethinQ RethinQ 是一个随机，双盲，对照研究，评估在窄QRS波心衰患者CRT疗效 入选标准： 最佳药物治疗基础上NYHA心功能分级III级 LVEF≤35％ QRS时限130ms 且有超声证实的机械收缩不同步 满足下述任一项不同步指标： SPWMD≥130ms或IVD ≥65ms Ts（间隔－侧壁）或Ts（前间隔－后壁） ≥65ms 一级终点： 峰值氧耗量 二级终点: 生活质量 NYHA分级 随访6个月 N Engl J Med 2007;357:2461-71. 患者分组 RethinQ N Engl J Med 2007;357:2461-71. RethinQ亚组分析 N Engl J Med 2007;357:2461-71. 一级终点 在QRS≥120 ms亚组中, 与对照组相比CRT最大摄氧量O2 耗量增加 (p = 0.02) 在QRS120 ms亚组中, 与对照组相比CRT最大摄氧量O2增加≥1.0 ml/kg/min，两组没有差异 二级终点 无论QRS波是否大于120ms，CRT组都能改善心功能分级。 生活质量，6分钟步行距离或超声指标两组没差异 RethinQ N Engl J Med 2007;357:2461-71. 结论 亚组分析提示： CRT改善QRS120 ms心衰患者的峰值氧耗量，并改善心功能。 CRT不能改善QRS=120ms的中重度心衰，机械不同步患者的峰值氧耗量，提示可能不能从中获益。 需要有进一步应用更特异的心肌影像标准的随机前瞻研究来确定这些技术在QRS≤120ms患者中选择可能对CRT有反应的价值 N Engl J Med 2007;357:2461-71. RethinQ * * * * * * * * N Engl J Med. 2007 Dec 13;357(24):2461-71. Epub 2007 Nov 6 BACKGROUND: Indications for cardiac-resynchronization therapy (CRT) in patients with heart failure include a prolonged QRS interval ( or =120 msec), in addition to other functional criteria. Some patients with narrow QRS complexes have echocardiographic evidence of left ventricular mechanical dyssynchrony and may also benefit from CRT. METHODS: We enrolled 172 patients who had a standard indication for an implantable cardioverter-defibrillator. Patients received the CRT device and were randomly assigned to the CRT group or to a control group (no CRT) for 6 months. The primary end point was the proportion of patients with an increase in peak oxygen consumption of at least 1.0 ml per kilogram of body weight per minute during cardiopulmonary exercise testing at 6 months. RESULTS: At 6 months, the CRT group and the control group did not differ significantly in the proportion of patients with the primary end point (46% and 41%, respectively). In a prespecified subgroup with a QRS interval of 120 msec or more, the peak oxygen consumption increased in the CRT group (P=0.02), but it was unchanged in a subgroup with a QRS interval of less than 120