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ハギワラ ノブヒサ
HAGIWARA Nobuhisa
萩原 誠久 所属 医学部 医学科（東京女子医科大学病院） 職種 客員教授 |
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| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | Time interval from left ventricular stimulation to QRS onset is a novel predictor of nonresponse to cardiac resynchronization therapy. |
| 掲載誌名 | 正式名：Heart rhythm 略 称：Heart Rhythm ISSNコード：1547-5271/1556-3871 |
| 掲載区分 | 国外 |
| 出版社 | Elsevier B.V. |
| 巻・号・頁 | 16(3),pp.395-402 |
| 著者・共著者 | YAGISHITA Daigo†, SHODA Morio*, YAGISHITA Yoshimi, EJIMA Koichiro, HAGIWARA Nobuhisa |
| 担当区分 | 最終著者 |
| 発行年月 | 2019/03 |
| 概要 | BACKGROUND:
Left ventricular (LV) lead placement at the late activation site (LAS) has been proposed as an optimal LV pacing site (ie, Q-LV interval). However, LAS may be relevant to local electrical conduction, measured as an interval from LV pacing stimulation to QRS onset (S-QRS interval). OBJECTIVE: The purpose of this study was to evaluate the prognostic value of S-QRS for reverse remodeling and the impact of S-QRS on pacing QRS configuration in patients undergoing cardiac resynchronization therapy (CRT). METHODS: Sixty consecutive heart failure patients with a wide QRS complex underwent CRT. A site with Q-LV ≥95 ms was targeted for LV lead placement. A responder was defined as one with >15% reduction in LV end-systolic volume 6 months after CRT. RESULTS: LV lead placement with Q-LV ≥95 ms was achieved in 52 of 60 patients (86.7%). Thirty-two of 52 patients (61.5%) were responders. S-QRS was significantly shorter in responders than nonresponders (P <.01), whereas Q-LV was not significantly different. A cutoff value of 37 ms for S-QRS had sensitivity and specificity of 81% and 90%, respectively. Shorter S-QRS (<37 ms) showed significantly narrower LV pacing QRS width and biventricular pacing QRS width compared to longer S-QRS. After multivariate analysis, PQ interval (odds ratio 0.97; P = .01) and long S-QRS ≥ 37ms (odds ratio 0.014; P <.01) were independent predictors of response to CRT. CONCLUSION: In addition to a sufficient Q-LV, S-QRS can be a useful indicator of optimal LV lead position to achieve reverse remodeling. S-QRS contributes to the pacing QRS configuration associated with CRT response. |
| DOI | 10.1016/j.hrthm.2018.08.035 |
| PMID | 30193853 |