Pitzalis Maria Vittoria, Iacoviello Massimo, Romito Roberta, Massari Francesco, Rizzon Brian, Luzzi Giovanni, Guida Pietro, Andriani Andrea, Mastropasqua Filippo, Rizzon Paolo
Institute of Cardiology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
J Am Coll Cardiol. 2002 Nov 6;40(9):1615-22. doi: 10.1016/s0735-1097(02)02337-9.
The value of interventricular and intraventricular echocardiographic asynchrony parameters in predicting reverse remodeling after cardiac resynchronization therapy (CRT) was investigated.
Cardiac resynchronization therapy has been suggested as a promising strategy in patients with severe heart failure and left bundle branch block (LBBB), but the entity of benefit is variable and no criteria are yet available to predict which patients will gain.
Interventricular and intraventricular mechanical asynchrony was evaluated in 20 patients (8 men and 12 women, 63 +/- 10 years) with advanced heart failure caused by ischemic (n = 4) or nonischemic dilated cardiomyopathy (n = 16) and LBBB (QRS duration of at least 140 ms) using echocardiographic Doppler measurements. Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were calculated before and one month after CRT. Patients with a LVESVI reduction of at least 15% were considered as responders.
Cardiac resynchronization therapy significantly improved ventricular volumes (LVEDVI from 150 +/- 53 ml/m(2) to 119 +/- 37 ml/m(2), p < 0.001; LVESVI from 116 +/- 43 ml/m(2) to 85 +/- 29 ml/m(2), p < 0.0001). At baseline, the responders had a significantly longer septal-to-posterior wall motion delay (SPWMD), a left intraventricular asynchrony parameter; only QRS duration and SPWMD significantly correlated with a reduction in LVESVI (r = -0.54, p < 0.05 and r = -0.70, p < 0.001, respectively), but the accuracy of SPWMD in predicting reverse remodeling was greater than that of the QRS duration (85% vs. 65%).
In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.
研究心室间和心室内超声心动图异步参数在预测心脏再同步治疗（CRT）后逆向重构中的价值。
心脏再同步治疗已被认为是重度心力衰竭和左束支传导阻滞（LBBB）患者的一种有前景的治疗策略，但获益情况存在差异，且尚无预测哪些患者将获益的标准。
使用超声心动图多普勒测量方法，对20例（8例男性和12例女性，年龄63±10岁）因缺血性（n = 4）或非缺血性扩张型心肌病（n = 16）及LBBB（QRS时限至少140毫秒）导致的晚期心力衰竭患者的心室间和心室内机械异步情况进行评估。在CRT前及CRT后1个月计算左心室舒张末期容积指数（LVEDVI）和左心室收缩末期容积指数（LVESVI）。LVESVI降低至少15%的患者被视为反应者。
心脏再同步治疗显著改善了心室容积（LVEDVI从150±53 ml/m²降至119±37 ml/m²，p < 0.001；LVESVI从116±43 ml/m²降至85±29 ml/m²，p < 0.0001）。在基线时，反应者的室间隔至后壁运动延迟（SPWMD）明显更长，这是一个左心室内异步参数；只有QRS时限和SPWMD与LVESVI的降低显著相关（分别为r = -0.54，p < 0.05和r = -0.70，p < 0.001），但SPWMD预测逆向重构的准确性高于QRS时限（85%对65%）。
在晚期心力衰竭和LBBB患者中，基线SPWMD是CRT后逆向重构发生的有力预测指标，这表明其在识别可能从双心室起搏中获益的患者方面具有实用性。
