Background:Patients with a class I recommendation for cardiac resynchronization therapy (CRT) are likely to benefit, but the effect of CRT in class II patients is more heterogeneous and additional selection parameters are needed in this group. The recently validated segment length in cine strain analysis of the septum (SLICE-ESS_sep) measurement on cardiac magnetic resonance cine imaging predicts left ventricular functional recovery after CRT but its prognostic value is unknown. This study sought to evaluate the prognostic value of SLICE-ESS_sep for clinical outcome after CRT.Methods:Two hundred eighteen patients with a left bundle branch block or intraventricular conduction delay and a class I or class II indication for CRT who underwent preimplantation cardiovascular magnetic resonance examination were enrolled. SLICE-ESS_sep was manually measured on standard cardiovascular magnetic resonance cine imaging. The primary combined end point was all-cause mortality, left ventricular assist device, or heart transplantation. Secondary end points were (1) appropriate implantable cardioverter defibrillator therapy and (2) heart failure hospitalization.Results:Two-thirds (65%) of patients had a positive SLICE-ESS_sep ≥0.9% (ie, systolic septal stretching). During a median follow-up of 3.8 years, 66 (30%) patients reached the primary end point. Patients with positive SLICE-ESS_sep were at lower risk to reach the primary end point (hazard ratio 0.36; P<0.001) and heart failure hospitalization (hazard ratio 0.41; P=0.019), but not for implantable cardioverter defibrillator therapy (hazard ratio, 0.66; P=0.272). Clinical outcome of class II patients with a positive ESS_sep was similar to those of class I patients (hazard ratio, 1.38 [95% CI, 0.66–2.88]; P=0.396).Conclusions:Strain assessment of the septum (SLICE-ESS_sep) provides a prognostic measure for clinical outcome after CRT. Detection of a positive SLICE-ESS_sep in patients with a class II indication predicts improved CRT outcome similar to those with a class I indication whereas SLICE-ESS_sep negative patients have poor prognosis after CRT implantation.

中文翻译：

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电影应变分析中的段长度可预测超出当前指南的心脏再同步治疗结果

背景：I 类推荐心脏再同步治疗 (CRT) 的患者可能会受益，但 CRT 在 II 类患者中的效果更加异质，该组需要额外的选择参数。最近在心脏磁共振电影成像的电影应变分析中验证的节段长度 (SLICE-ESS _sep ) 测量可预测 CRT 后的左心室功能恢复，但其预后价值未知。本研究旨在评估 SLICE-ESS _sep的预后价值方法：218例左束支传导阻滞或脑室内传导延迟符合CRTⅠ类或Ⅱ类指征并行植入前心血管磁共振检查的患者。SLICE-ESS _sep是在标准心血管磁共振电影成像上手动测量的。主要联合终点是全因死亡率、左心室辅助装置或心脏移植。次要终点是 (1) 适当的植入式心律转复除颤器治疗和 (2) 心力衰竭住院治疗。 结果：三分之二 (65%) 的患者具有阳性 SLICE-ESS _sep≥0.9%（即收缩期间隔拉伸）。在中位随访 3.8 年期间，66 名（30%）患者达到了主要终点。SLICE-ESS _sep阳性患者达到主要终点（风险比 0.36；P <0.001）和心力衰竭住院（风险比 0.41；P = 0.019）的风险较低，但植入式心脏复律除颤器治疗的风险较低（风险比, 0.66; P = 0.272)。具有阳性 ESS _{sep 的}II 类患者的临床结果与 I 类患者相似（风险比，1.38 [95% CI，0.66-2.88]；P = 0.396）。结论：隔膜的应变评估（SLICE-ESS_九月) 提供了 CRT 后临床结果的预后指标。在具有 II 类指征的患者中检测到阳性 SLICE-ESS _sep预测 CRT 结果的改善与具有 I 类指征的患者相似，而 SLICE-ESS _sep阴性患者在 CRT 植入后预后较差。