Soliman Osama I I, Theuns Dominic A M J, ten Cate Folkert J, Anwar Ashraf M, Nemes Attila, Vletter Wim B, Jordaens Luc J, Geleijnse Marcel L
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2007 Aug 1;100(3):464-9. doi: 10.1016/j.amjcard.2007.03.047. Epub 2007 Jun 13.
We evaluated the value of baseline parameters derived from tissue Doppler imaging (TDI) for event prediction in patients with heart failure (HF) secondary to ischemic and nonischemic cause who underwent cardiac resynchronization therapy (CRT). Seventy-four consecutive patients with HF (mean age 59 +/- 11 years) underwent CRT. Baseline clinical parameters included New York Heart Association class, 6-minute walking distance, HF cause, and diabetes. TDI-derived parameters included lateral and septal E/E' ratios defined as peak early left ventricular (LV) filling velocity (E wave) to TDI-derived peak early diastolic velocity of the mitral annulus (E' wave). During a median follow-up of 720 days, 21 patients (28%) had cardiac death or hospitalization for HF. These patients more often had an ischemic cause (p <0.05), diabetes (p <0.05), and restrictive filling (p <0.001), less often had LV dyssynchrony (p <0.05), and had higher septal and lateral E/E' ratios (p <0.001 for the 2 comparisons). In a multivariable model using a forward selection algorithm, only the lateral E/E' ratio remained an independent predictor of cardiac outcome. After 3 months of CRT, TDI-derived systolic mitral annular systolic and diastolic velocities improved significantly in nonischemic patients for the septal and lateral sides. In contrast, in ischemic patients no significant improvements were seen. Significant improvements were seen in septal and lateral E/E' ratios in ischemic and nonischemic patients. However, the improvement in lateral E/E' ratio was significantly less and absolute 3-months E/E' ratios were worse in ischemic patients. In conclusion, baseline lateral E/E' ratio is an independent predictor for cardiac events in patients with HF treated with CRT. The worse clinical outcome in ischemic patients may be due to failure of improvement in systolic and diastolic mitral annular velocities after CRT, resulting in a less pronounced improvement in LV filling pressures as demonstrated by this E/E' ratio.
我们评估了组织多普勒成像（TDI）得出的基线参数对因缺血性和非缺血性病因导致心力衰竭（HF）且接受心脏再同步治疗（CRT）患者的事件预测价值。74例连续的HF患者（平均年龄59±11岁）接受了CRT。基线临床参数包括纽约心脏协会分级、6分钟步行距离、HF病因和糖尿病。TDI得出的参数包括侧壁和间隔E/E'比值，定义为左心室（LV）早期充盈峰值速度（E波）与TDI得出的二尖瓣环舒张早期峰值速度（E'波）之比。在中位随访720天期间，21例患者（28%）发生心源性死亡或因HF住院。这些患者更常因缺血性病因（p<0.05）、糖尿病（p<0.05）和限制性充盈（p<0.001），较少出现LV不同步（p<0.05），且具有更高的间隔和侧壁E/E'比值（两项比较均p<0.001）。在使用向前选择算法的多变量模型中，只有侧壁E/E'比值仍然是心脏结局的独立预测因素。CRT治疗3个月后，非缺血性患者间隔和侧壁的TDI得出的二尖瓣环收缩期和舒张期速度显著改善。相比之下，缺血性患者未见显著改善。缺血性和非缺血性患者的间隔和侧壁E/E'比值均有显著改善。然而，缺血性患者侧壁E/E'比值的改善明显较小，且3个月时的绝对E/E'比值更差。总之，基线侧壁E/E'比值是接受CRT治疗的HF患者心脏事件的独立预测因素。缺血性患者较差的临床结局可能是由于CRT后二尖瓣环收缩期和舒张期速度未能改善，导致LV充盈压改善不明显，如该E/E'比值所示。
