シヨウダ　モリオ   Shiyouda Morio   庄田　守男    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門教授
言語種別	日本語
発表タイトル	Can We Predict the Responders to Cardiac Resynchronization Therapy?
会議名	第79回日本循環器学会学術集会
主催者	日本循環器学会
学会区分	全国規模の学会
発表形式	口頭
発表者・共同発表者	◎眞中哲之, 庄田守男, 萩原誠久
発表年月日	2015/04/25
開催地 （都市, 国名）	大阪市
概要	*Controversy3 Though cardiac resynchronization therapy (CRT) is shown to be effective in eligible patients with heart failure with systolic dysfunction, there are 30-50% of the patients still classified as non-responders. Identifying the responders remains challenging, since there are a lot of parameters affecting the response to CRT (patient selection, lead location, pacing rate, scar burden, pacing optimization, suboptimal medication etc.). Many criteria to define a positive response to CRT have been used with a wide variability between studies. As the several multicenter studies have demonstrated that the several parameters such as narrow QRS, non-LBBB morphology and much scar burden, are associated with non-response to CRT, predicting the non-responders by ECG, echo or any imaging tools seems easier than predicting the responders. In PROSPECT trial, echocardiographic measures of dyssynchrony aimed at improving patient selection criteria for CRT do not appear to have a clinically relevant impact on improving response rates. However, there are more parameters under the investigation to predict the possible responders or even the super-responders. Many studies are still supporting the echo parameters (combined index of radial strain echo, acute improvement of LV relaxation etc.), and some others are supporting the ECG parameters (interval between R wave peak to S wave peak, reduction of QRS duration after CRT, fragmented QRS etc.), SPECT or MRI etc. There are also some studies proposing the assessment of combined parameters of echo and ECG, and there is another recent study even showing the genetic markers as a predictor. In this lecture, the outline of recent challenges for predicting the responders will be interpreted.