Penicka Martin, Bartunek Jozef, De Bruyne Bernard, Vanderheyden Marc, Goethals Marc, De Zutter Marc, Brugada Pedro, Geelen Peter
Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
Circulation. 2004 Mar 2;109(8):978-83. doi: 10.1161/01.CIR.0000116765.43251.D7. Epub 2004 Feb 9.
Cardiac resynchronization therapy was shown to reverse left ventricular (LV) remodeling in patients with congestive heart failure (CHF). However, the prediction of benefit is controversial. We aimed to investigate predictive factors of LV functional recovery and reversed remodeling after biventricular pacing.
Forty-nine consecutive patients with CHF and a wide QRS complex (182+/-32 ms) were studied by echocardiography before resynchronization. Intraventricular and interventricular asynchrony and their combination were assessed by pulsed-wave tissue Doppler imaging from measurements of regional electromechanical coupling times in basal segments of the right and left ventricle. At 6-month follow-up, responders were defined by a relative increase in LV ejection fraction > or =25% compared with baseline (n=27). Receiver operating curve analysis revealed the degree of intraventricular asynchrony (area under the curve=0.77), interventricular asynchrony (area under the curve=0.69), and their combination (area under the curve=0.84) as the best predictors of functional recovery after resynchronization. In addition, the degree of intraventricular and interventricular asynchrony correlated significantly with the improvement of LV ejection fraction (r=0.73, P<0.0001), end-diastolic diameter (r=-0.59, P<0.0001), and end-systolic diameter (r=-0.48, P<0.001) at follow-up. QRS duration and conventional echo-Doppler indices were not predictive of reversed LV remodeling.
In patients with CHF, the degree of intraventricular and interventricular asynchrony and their combination are the best predictive factors of LV functional recovery and reversed remodeling after cardiac resynchronization therapy.
心脏再同步治疗已被证明可逆转充血性心力衰竭（CHF）患者的左心室（LV）重构。然而，获益的预测存在争议。我们旨在研究双心室起搏后左心室功能恢复和逆转重构的预测因素。
对49例连续的CHF且QRS波增宽（182±32毫秒）患者在再同步治疗前进行超声心动图检查。通过脉冲波组织多普勒成像测量右心室和左心室基底部节段的局部机电耦联时间，评估心室内和心室间不同步及其组合情况。在6个月随访时，与基线相比左心室射血分数相对增加≥25%的患者被定义为反应者（n = 27）。受试者工作特征曲线分析显示，心室内不同步程度（曲线下面积 = 0.77）、心室间不同步程度（曲线下面积 = 0.69）及其组合（曲线下面积 = 0.84）是再同步治疗后功能恢复的最佳预测指标。此外，心室内和心室间不同步程度与随访时左心室射血分数的改善（r = 0.73，P < 0.0001）、舒张末期直径（r = -0.59，P < 0.0001）和收缩末期直径（r = -0.48，P < 0.001）显著相关。QRS波时限和传统超声多普勒指标不能预测左心室重构的逆转。
在CHF患者中，心室内和心室间不同步程度及其组合是心脏再同步治疗后左心室功能恢复和逆转重构的最佳预测因素。
