Ghio Stefano, Freemantle Nick, Serio Alessandra, Magrini Giulia, Scelsi Laura, Pasotti Michele, Cleland John G F, Tavazzi Luigi
Division of Cardiology, IRCCS Policlinico S. Matteo, University Hospital, Pavia, Italy.
Eur J Echocardiogr. 2006 Oct;7(5):373-8. doi: 10.1016/j.euje.2005.10.006. Epub 2005 Dec 5.
Information on the prevalence and clinical, electrocardiographic and echocardiographic inter-relationships of mechanical dyssynchrony among patients with heart failure (HF) and left ventricular systolic dysfunction derives mainly from relatively small studies. The CARE-HF trial provides the opportunity to address these issues in a large population of patients with advanced HF.
The CARE-HF trial enrolled patients with New York Heart Association (NYHA) class III or IV HF, with a QRS duration > or =120 ms, left ventricular (LV) ejection fraction (EF) < or =35% and LV end diastolic diameter > or =30 mm/m (height in m). Patients underwent a thorough echocardiographic evaluation, which included assessment of LV structure, systolic function, mitral inflow pattern, right ventricular (RV) dimensions and function, and interventricular mechanical delay (IVMD) as an index of interventricular dyssynchrony. Echocardiographic measurements were made in a Core Laboratory to ensure consistent quantitative analysis. Of the 813 patients enrolled, 735 had a baseline echocardiographic examination suitable for measurement. Overall patients had advanced LV dysfunction (mean EF 25.5%) but few had a restrictive mitral filling pattern (18%) and both the mean RV diameter and RV function were within normal limits. Interventricular dyssynchrony defined as IVMD >40 ms was present in 455 patients (62%). Clinical, electrocardiographic and standard echocardiographic variables were only loosely associated with IVMD.
Interventricular dyssynchrony appears to be an independent characteristic of patients with advanced HF, and is poorly related to clinical, electrocardiographic or standard echocardiographic variable.
心力衰竭（HF）和左心室收缩功能障碍患者中机械性不同步的患病率以及临床、心电图和超声心动图之间的相互关系信息主要来自相对较小规模的研究。心脏再同步治疗心力衰竭（CARE - HF）试验为在大量晚期HF患者中解决这些问题提供了契机。
CARE - HF试验纳入了纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级的HF患者，其QRS时限≥120毫秒，左心室（LV）射血分数（EF）≤35%且左心室舒张末期直径≥30毫米/米（身高，单位为米）。患者接受了全面的超声心动图评估，包括评估左心室结构、收缩功能、二尖瓣血流模式、右心室（RV）尺寸和功能，以及将心室间机械延迟（IVMD）作为心室间不同步的指标。超声心动图测量在一个核心实验室进行，以确保一致的定量分析。在纳入的813例患者中，735例进行了适合测量的基线超声心动图检查。总体患者存在严重的左心室功能障碍（平均EF为25.5%），但很少有二尖瓣充盈受限模式（18%），并且右心室平均直径和右心室功能均在正常范围内。455例患者（62%）存在定义为IVMD>40毫秒的心室间不同步。临床、心电图和标准超声心动图变量与IVMD仅存在松散关联。
心室间不同步似乎是晚期HF患者的一个独立特征，并且与临床、心电图或标准超声心动图变量关系不大。
