Title: Resynchronization Therapy in Patients with Narrow QRS
                 -- QRS间隙变窄患者进行再同步手术
Topic(s): Heart Failure/Transplant
话题：心力衰竭∕移植
Description
The goal of the trial was to evaluate cardiac resynchronization therapy (CRT) among patients with heart failure with narrow QRS complexes who were implanted with an implantable cardioverter defibrillator (ICD).
Drugs/Procedures Used
Approximately 14 days after implantation of ICD, patients were randomized in a double-blind manner to cardiac resynchronization treatment (CRT ON; n = 85) or no receive cardiac resynchronization treatment (CRT OFF; n = 87). At baseline and 6 months, cardiopulmonary exercise stress testing, an ECG, and a quality of life questionnaire were performed.
Principal Findings
At baseline, the mean QRS interval was 107 msec, with 27% of patients having a QRS ≥120 msec. Indication for ICD was primary prevention in the majority of patients (85%) and secondary prevention in 15%. Heart disease etiology was ischemic in 52% of patients. Mean ejection fraction was 25%. Approximately one-quarter had moderate mitral regurgitation. Peak oxygen consumption averaged 12 ml/kg/min and exercise duration was 9 minutes.
The primary endpoint of increase in peak oxygen consumption ≥1.0 ml/kg of body weight per minute did not differ between the CRT group and the control group (46% vs. 41%, p = NS). There was also no difference in change in quality of life scores (median -8 vs -7, p = 0.91), change in 6-minute walking test (median 26 vs. 6, p = 0.23), or change in ejection fraction (median 1.2 vs. 2.0, p = 0.83). Improvement in NYHA class of ≥1 class was more common in the CRT group than the control group (54% vs. 29%, p = 0.006). Among the subgroup of patients with a QRS interval ≥120 msec, peak oxygen consumption increased in the CRT group compared with the control group (p = 0.02), but did not differ in the subgroup of patients with a QRS interval <120 msec (p = 0.45). By 6 months, there were 5 deaths in the CRT group and 1 in the control group (p = 0.11).
描述：试验的目的是测量在心力衰竭病人中CRT的手术情况，这类病人还患有QRS狭窄，并在体内移入ICD。
大约在ICD移入病人体内１４天后，病人被随机分到双目失明的病人接受CRT的小组(CRT ON; n = 85)，或者没有接受CRT的小组中(CRT OFF; n = 87)，他们在这些小组中经过６个月的时间，完成了肺活量测验，ECG，生命体征调查等。
主要发现：
从基线上可以看出，平均QRS间隔是107 msec，２７％的患者的QRS≥120 msec在大多数病人中(85%)ICD主要是预防，15%的患者中ICD是二级预防。５２％心脏病患者是由于局部缺血造成的排出物所占的比例是２５％。大约有四分之一的排出物还要进行回流。氧气消耗平均达到12 ml/kg/min。
病人每分钟所消耗的氧气≥1.0 ml/kg，氧气消耗量的增加在CRT group 和control group (46% vs. 41%, p = NS)并没有什么区别。在生活质量上也没有什么变化(median -8 vs -7, p = 0.91)。在６分钟的步行测验中有所变化(median 26 vs. 6, p = 0.23)，身体的排出物有变化(median 1.2 vs. 2.0, p = 0.83)。NYHA class of ≥1 class的改进与CRT group有更多的相同之处。(54% vs. 29%, p = 0.006)　。在QRS interval ≥120 msec病人群中，CRT group病人氧气消耗较control group有所增加(p = 0.02)，但在QRS interval <120 msec (p = 0.45)病人中并没有什么不同。经过６个月，CRT group有５名患者死亡，control group有１名患者死亡(p = 0.11)。
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