心脏再同步治疗后左心室舒张功能的改善与收缩功能的反应相关。

Improvements in left ventricular diastolic function after cardiac resynchronization therapy are coupled to response in systolic performance.

作者信息

Waggoner Alan D, Faddis Mitchell N, Gleva Marye J, de las Fuentes Lisa, Dávila-Román Víctor G

机构信息

Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

出版信息

J Am Coll Cardiol. 2005 Dec 20;46(12):2244-9. doi: 10.1016/j.jacc.2005.05.094.

DOI:10.1016/j.jacc.2005.05.094

PMID:16360053

Abstract

OBJECTIVES

To determine the short-term effects of cardiac resynchronization therapy (CRT) on measurements of left ventricular (LV) diastolic function in patients with severe heart failure.

BACKGROUND

Cardiac resynchronization therapy improves systolic performance; however, the effects on diastolic function by load-dependent pulsed-wave Doppler transmitral indices has been variable.

METHODS

Fifty patients with severe heart failure were evaluated by two-dimensional Doppler echocardiography immediately prior to and 4 +/- 1 month after CRT. Measurements included LV volumes and ejection fraction (EF), pulsed-wave Doppler (PWD)-derived transmitral filling indices (E- and A-wave velocities, E/A ratio, deceleration time [DT], diastolic filling time [DFT], and isovolumic relaxation time). Tissue Doppler imaging was used for measurements of systolic and diastolic (Em) velocities at four mitral annular sites; mitral E-wave/Em ratio was calculated to estimate LV filling pressure. Color M-mode flow propagation velocities were also obtained.

RESULTS

After CRT, LV volumes decreased significantly (p < 0.001) and LVEF increased >5% in 28 of 50 patients (56%) and were accompanied by reduction in PWD mitral E-wave velocity and E/A ratio (both p < 0.01), increased DT and DFT (both p < 0.01), and lower filling pressures (i.e., E-wave/Em septal; p < 0.01). Patients with LVEF response < or =5% after CRT had no significant changes in measurements of diastolic function; LV relaxation (i.e., Em velocities) worsened in this group.

CONCLUSIONS

In heart failure patients receiving CRT, improvement in LV diastolic function is coupled to the improvement in LV systolic function.

摘要

目的

确定心脏再同步治疗（CRT）对重度心力衰竭患者左心室（LV）舒张功能测量值的短期影响。

背景

心脏再同步治疗可改善收缩功能；然而，负荷依赖性脉冲波多普勒经二尖瓣指数对舒张功能的影响一直存在差异。

方法

50例重度心力衰竭患者在CRT治疗前及治疗后4±1个月接受二维多普勒超声心动图评估。测量指标包括左心室容积和射血分数（EF）、脉冲波多普勒（PWD）得出的经二尖瓣充盈指数（E波和A波速度、E/A比值、减速时间[DT]、舒张充盈时间[DFT]和等容舒张时间）。组织多普勒成像用于测量二尖瓣环四个部位的收缩期和舒张期（Em）速度；计算二尖瓣E波/Em比值以估计左心室充盈压。还获得了彩色M型血流传播速度。

结果

CRT治疗后，50例患者中有28例（56%）左心室容积显著减小（p<0.001），左心室射血分数增加>5%，同时PWD二尖瓣E波速度和E/A比值降低（均p<0.01），DT和DFT增加（均p<0.01），充盈压降低（即E波/Em间隔；p<0.01）。CRT治疗后左心室射血分数反应≤5%的患者舒张功能测量值无显著变化；该组左心室舒张功能（即Em速度）恶化。