Cardiac resynchronization therapy in heart failure based on Strauss criteria for left bundle branch block.

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS ESC Heart Failure Pub Date : 2024-09-20 DOI:10.1002/ehf2.15028

Athanasios Saplaouras, Konstantinos Vlachos, Panagiotis Mililis, Athena Batsouli, George Bazoukis, Sotirios Xydonas, Panagioula Niarchou, Antonio Frontera, Stylianos Dragasis, Ourania Kariki, Ilias G Patsiotis, Aggeliki Gkouziouta, Panagiotis Stachteas, Panagiotis Korantzopoulos, Stylianos Tzeis, Nikolaos Fragakis, Michael Efremidis, Konstantinos P Letsas

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Abstract

Aims: The left bundle branch block (LBBB) is a strong predictor of response to cardiac resynchronization therapy (CRT). However, a significant number of patients do not respond to the treatment. The study sought to evaluate the impact of the stricter Strauss criteria for left bundle branch block (St-LBBB) on CRT response, hospitalizations, ventricular arrhythmia (VA) events and mortality.

Methods: This study is a retrospective analysis of prospectively collected data on heart failure (HF) patients with LBBB admitted for CRT implantation. Patients were divided into two groups according to the fulfilment or not of St-LBBB criteria.

Results: The study included 82 patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy [46 (56%) with St-LBBB and 36 (44%) with non-St-LBBB]. Patients with St-LBBB showed higher CRT response rates compared with those with non-St-LBBB (P < 0.01), while the group with NICM exhibited the greatest benefit (P < 0.01). St-LBBB CRT responders displayed significantly lower rates of HF hospitalization (P < 0.0001) compared with the non-St-LBBB group. According to Kaplan-Meier time curves, this was primarily evident in patients with NICM (P < 0.0001). CRT responders displayed significantly fewer VA events (P < 0.001) and lower mortality rates (P < 0.0001) than non-responders. Kaplan-Meier estimates demonstrated a significantly lower incidence of VAs in NICM patients with St-LBBB (P = 0.049) compared with ICM patients with St-LBBB (P = 0.25). Lower mortality rates were observed in CRT responders than non-responders (P < 0.0001), with the group of NICM with St-LBBB criteria exhibiting the greatest benefit (P = 0.0238).

Conclusions: Patients with NICM and St-LBBB present the greatest benefit concerning CRT response, HF hospitalizations, VA events and mortality. Although St-LBBB criteria seem to improve patient selection for CRT, more data are needed to elucidate the role of St-LBBB criteria in this setting.

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根据施特劳斯左束支传导阻滞标准对心力衰竭进行心脏再同步化治疗。

目的：左束支传导阻滞（LBBB）是预测心脏再同步化治疗（CRT）反应的一个重要指标。然而，相当多的患者对治疗没有反应。该研究旨在评估更严格的左束支传导阻滞施特劳斯标准（St-LBBB）对 CRT 反应、住院、室性心律失常（VA）事件和死亡率的影响：本研究是对前瞻性收集的接受 CRT 植入术的 LBBB 心衰（HF）患者数据的回顾性分析。根据是否符合St-LBBB标准将患者分为两组：研究纳入了82名缺血性（ICM）和非缺血性（NICM）心肌病患者[其中46人（56%）符合St-LBBB标准，36人（44%）不符合St-LBBB标准]。与非 St-LBBB 患者相比，St-LBBB 患者的 CRT 反应率更高（P 结论：St-LBBB 患者的 CRT 反应率高于非 St-LBBB 患者）：NICM 和 St-LBBB 患者在 CRT 反应、高频住院、VA 事件和死亡率方面获益最大。虽然 St-LBBB 标准似乎能改善 CRT 患者的选择，但仍需要更多数据来阐明 St-LBBB 标准在这种情况下的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.