Perego Giovanni B, Valsecchi Sergio, Censi Federica, Schreuder Jan J, Padeletti Luigi
Istituto Auxologico Italiano, Ospedale S. Luca, Via Spagnoletto 3, 20149, Milan, Italy.
J Clin Monit Comput. 2008 Dec;22(6):435-43. doi: 10.1007/s10877-008-9153-9. Epub 2008 Dec 12.
Coherent averaging is a technique to recover the response to repetitively applied stimuli when that response is embedded in random noise. We derived novel indices for left ventricular dyssynchrony estimation from volume-catheter signals using coherent averaging procedure: mechanical dyssynchrony (DYSCoh) internal flow fraction (IFFCoh) and mechanical dispersion (DISPCoh). The percentage power of non-repetitive components in the volume signals (ResTotAvg) was also estimated. The aims of the study were to evaluate the indices, characterizing repetitive and non-recurrent components of the conductance-volume signals, and to assess the ability of these indices to detect the changes in dyssynchrony induced by biventricular pacing (BIV).
We compared the results obtained in 20 heart failure patients indicated to BIV (HF Group) during spontaneous conduction with the results from 12 patients with preserved ventricular function (non-HF Group), and with those obtained during BIV.
DISPCoh and ResTotAvg were significantly different in HF compared to non-HF group, and identified HF patients with high accuracy (area under curve at ROC analysis > 0.8). These indices also demonstrated significant differences after BIV (p = 0.047 and p = 0.037 respectively) and their baseline values correlated with the acute increase of stroke volume (r = 0.64 and r = 0.78, both with p < 0.005).
Coherent averaging-based indices permit independent quantification and differentiation of repetitive components of ventricular dyssynchrony from non-recurrent mechanical non-uniformities, which seem associated with HF and conduction disturbances. These indices identified HF patients with high accuracy, and were able to describe the reversal of dyssynchrony caused by BIV and to predict the acute hemodynamic improvement.
相干平均是一种在响应被随机噪声掩盖时恢复对重复施加刺激的响应的技术。我们使用相干平均程序从容积导管信号中得出了用于估计左心室不同步的新指标：机械不同步（DYSCoh）、内部血流分数（IFFCoh）和机械离散度（DISPCoh）。还估计了容积信号中非重复成分的功率百分比（ResTotAvg）。本研究的目的是评估这些指标，表征电导-容积信号的重复和非重复成分，并评估这些指标检测双心室起搏（BIV）引起的不同步变化的能力。
我们将20例接受BIV治疗的心力衰竭患者（HF组）在自发传导期间获得的结果与12例心室功能正常的患者（非HF组）的结果以及BIV期间获得的结果进行了比较。
与非HF组相比，HF组的DISPCoh和ResTotAvg有显著差异，并且能以较高准确率识别HF患者（ROC分析曲线下面积>0.8）。这些指标在BIV后也显示出显著差异（分别为p = 0.047和p = 0.037），且其基线值与每搏输出量的急性增加相关（r = 0.64和r = 0.78，均p < 0.005）。
基于相干平均的指标能够独立量化和区分心室不同步的重复成分与非反复性机械不均匀性，后者似乎与HF和传导障碍有关。这些指标能以较高准确率识别HF患者，能够描述BIV引起的不同步逆转情况，并预测急性血流动力学改善情况。
