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Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure

机译：心力衰竭住院患者进行心脏再同步治疗的资格

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Aims Recent guidelines recommend cardiac resynchronization therapy (CRT) in mildly symptomatic heart failure (HF) but favour left bundle branch block (LBBB) morphology in patients with moderate QRS prolongation (120–150?ms). We defined how many patients hospitalized with HF fulfil these criteria. Methods and results A single‐centre retrospective cohort study of 363 consecutive patients hospitalized with HF (438 admissions) was performed. Electronic imaging, electrocardiograms, and records were reviewed. Overall, 153 patients (42%) had left ventricular ejection fraction (LVEF)?≤?35%, and 34% of patients had QRS prolongation. Eighty patients (22%) were potentially eligible with LVEF?≤?35% and QRS?≥?120?ms or existing CRT. The majority (68 of 80) had a Class I or IIa recommendation according to international guidelines (LBBB or non‐LBBB QRS?≥?150?ms or right ventricular pacing). Only a minority (12 of 80) had moderate QRS prolongation of non‐LBBB morphology. One‐quarter ( n ?=?22) of patients fulfilling criteria were ineligible for reasons including dementia, co‐morbidities, or palliative care. A further eight patients required optimization of medical therapy. CRT was therefore immediately indicated in 50 patients. Of these, 29 were implanted or had existing CRT systems. Twenty‐one of the 80 patients eligible for CRT were not identified or treated (6% of the total hospitalized cohort). Conclusions Twenty‐two per cent of elderly real‐life patients hospitalized with HF fulfil LVEF and QRS criteria for CRT, most having a Class I or IIa indication. However, a large proportion is ineligible owing to co‐morbidities or requires medical optimization. Although uptake of CRT was reasonable, there remain opportunities for improvement.
机译：目的最近的指南建议对轻度症状性心力衰竭（HF）进行心脏再同步治疗（CRT），但对中度QRS延长（120–150？ms）的患者偏爱左束支传导阻滞（LBBB）形态。我们定义了多少HF住院患者符合这些标准。方法和结果进行了一项单中心回顾性队列研究，共纳入363例住院的HF患者（438例入院）。电子成像，心电图和记录进行了审查。总体上，有153例患者（42％）的左室射血分数（LVEF）≤35％，而34％的患者QRS延长。八十名患者（22％）可能符合LVEF≤35％和QRS≥120ms或已有CRT的条件。多数（80名患者中的68名）根据国际指南（LBBB或非LBBB QRS≥150µms或右心室起搏）推荐I级或IIa级。只有少数（80个中的12个）具有非LBBB形态的中度QRS延长。符合标准的患者中有四分之一（n = 22）不符合资格，原因包括痴呆，合并症或姑息治疗。另外八名患者需要优化药物治疗。因此，立即在50例患者中显示了CRT。其中，有29个已植入或已有CRT系统。在80例符合CRT的患者中，有21例未被鉴定或接受治疗（占住院总人数的6％）。结论HF住院的现实生活中，有22％的患者符合CRT的LVEF和QRS标准，大多数具有I级或IIa级适应症。但是，由于合并症或需要医疗优化，很大一部分不合格。尽管采用CRT是合理的，但仍有改进的机会。

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