Perez de Isla Leopoldo, Ortiz Oficialdegui Pilar, Florit Jose, Angel Garcia-Fernandez Miguel, Sanchez Violeta, Zamorano José
Hospital Clinico San Carlos, Madrid, Spain.
J Am Soc Echocardiogr. 2006 Nov;19(11):1338-44. doi: 10.1016/j.echo.2006.05.015.
Specific evaluation using echocardiographic Doppler is superior to the measurement of the QRS complex to detect cardiac asynchrony. Nevertheless, no clinical, electrocardiographic, or echocardiographic parameters have been evaluated to obtain an accurate and easy-to-use marker of cardiac asynchrony in patients with depressed left ventricular (LV) ejection fraction. Our aim was to determine whether there is any marker of cardiac asynchrony in patients with LV systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy.
In all, 316 consecutive patients with LV ejection fraction less than 40% were enrolled. Interventricular asynchrony was defined as an interventricular mechanical delay longer than 40 milliseconds. Intraventricular asynchrony was defined as the difference between time from Q wave to LV ejection end and the time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging greater than 50 milliseconds.
In all, 177 (56%) had ischemic and 139 (44%) had nonischemic heart disease. The logistic regression analysis showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease (odds ratio and 95% confidence interval 7.2 [3.9-13.4], P < .001; 5.99 [2.7-13.2], P < .001; and 8.75 [3.2-23.8], P < .001 for the total population, ischemic and nonischemic groups, respectively). Nevertheless, none of the studied parameters was found as a predictor of intraventricular asynchrony.
The presence of left bundle branch block is a marker of interventricular asynchrony in patients with ventricular dysfunction despite the cause of the underlying cardiac disease. Nevertheless, intraventricular cardiac asynchrony cannot be detected using conventional parameters. A specific echocardiographic evaluation before cardiac resynchronization therapy must be performed in all these patients. Our aim was to determine whether there is any marker of cardiac asynchrony in patients with left ventricular systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy. Our results showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease but none of the studied parameters was found as a predictor of intraventricular asynchrony.
使用超声心动图多普勒进行特异性评估在检测心脏不同步方面优于QRS波群测量。然而，尚未评估任何临床、心电图或超声心动图参数以获得左心室（LV）射血分数降低患者准确且易于使用的心脏不同步标志物。我们的目的是确定左心室收缩功能障碍患者中是否存在任何心脏不同步标志物，使我们能够在心脏再同步治疗前避免进行特定的超声心动图检查。
共纳入316例连续的左心室射血分数低于40%的患者。心室间不同步定义为心室间机械延迟超过40毫秒。心室内不同步定义为通过多普勒组织成像测量的从Q波到左心室射血结束的时间与从Q波到最延迟的基底节段收缩波结束的时间之差大于50毫秒。
总共177例（56%）患有缺血性心脏病，139例（44%）患有非缺血性心脏病。逻辑回归分析显示，无论潜在疾病的病因如何，仅左束支传导阻滞的存在是心室间不同步的独立预测因素（总体人群、缺血性和非缺血性组的比值比和95%置信区间分别为7.2[3.9 - 13.4]，P <.001；5.99[2.7 - 13.2]，P <.001；8.75[3.2 - 23.8]，P <.001）。然而，未发现所研究的参数中有任何一个是心室内不同步的预测因素。
无论潜在心脏病的病因如何，左束支传导阻滞的存在是心室功能障碍患者心室间不同步的标志物。然而，使用传统参数无法检测到心室内心脏不同步。所有这些患者在心脏再同步治疗前必须进行特定的超声心动图评估。我们的目的是确定左心室收缩功能障碍患者中是否存在任何心脏不同步标志物，使我们能够在心脏再同步治疗前避免进行特定的超声心动图检查。我们的结果显示，无论潜在疾病的病因如何，仅左束支传导阻滞的存在是心室间不同步的独立预测因素，但未发现所研究的参数中有任何一个是心室内不同步的预测因素。
