D'Andrea Antonello, Caso Pio, Scarafile Raffaella, Riegler Lucia, Salerno Gemma, Castaldo Francesca, Gravino Rita, Cocchia Rosangela, Del Viscovo Luca, Limongelli Giuseppe, Di Salvo Giovanni, Ascione Luigi, Iengo Raffaele, Cuomo Sergio, Santangelo Lucio, Calabrò Raffaele
Department of Cardiology, Second University of Naples, Martucci 35, 80121 Naples, Italy.
Eur J Heart Fail. 2009 Jan;11(1):58-67. doi: 10.1093/eurjhf/hfn010.
To evaluate whether quantification of the extent of scarred left ventricular (LV) tissue by speckle-tracking strain echo (2DSE) can predict response to cardiac resynchronization therapy (CRT) in patients with ischaemic dilated cardiomyopathy (DCM).
Forty-five patients (58.3 +/- 8.3 years; 24 males) with ischaemic DCM scheduled for CRT, and 25 controls were studied. A week before implantation all the patients underwent standard Doppler echo, 2DSE, and contrast-enhanced magnetic resonance (MR). Clinical and echocardiographic evaluation was repeated 6 months after CRT. The patients were considered as responders to CRT if LV end-systolic volume decreased by 15%. In DCM patients, LV ejection fraction was 29.2 +/- 5.1%. By evaluating the 765 segments with MR, subendocardial infarct was identified in 17.0% and transmural infarct in 18.3%. With 2DSE, the average global longitudinal strain (GLS) was -23.1 +/- 3.6% in controls and -15.1 +/- 5.1% in DCM (P = 0.001). GLS showed a close correlation with total scar burden using MR (r = 0.64, P < 0.001). At follow-up, patients were subdivided into responders (n = 30; 66.7%) and non-responders (n = 15; 33.3%) to CRT. GLS was significantly different in non-responders than in responders (GLS: -10.4 +/- 5.1 in non-responders vs. -18.4 +/- 14% in responders, P < 0.001). In a multivariable analysis, GLS (P < 0.0001) and radial intraventricular dyssynchrony (P < 0.001) were powerful independent determinants of response to CRT.
GLS is strongly associated with total scar burden assessed by MR, and is an excellent independent predictor of response to CRT.
评估通过斑点追踪应变超声心动图（2DSE）对瘢痕化左心室（LV）组织范围进行量化，是否能够预测缺血性扩张型心肌病（DCM）患者对心脏再同步治疗（CRT）的反应。
对45例计划接受CRT的缺血性DCM患者（年龄58.3±8.3岁；男性24例）以及25例对照者进行研究。植入前一周，所有患者均接受标准多普勒超声心动图、2DSE和对比增强磁共振成像（MR）检查。CRT治疗6个月后重复进行临床和超声心动图评估。若左心室收缩末期容积降低15%，则患者被视为CRT治疗反应者。在DCM患者中，左心室射血分数为29.2±5.1%。通过MR评估765个节段，发现17.0%存在心内膜下梗死，18.3%存在透壁梗死。采用2DSE检查时，对照组的平均整体纵向应变（GLS）为-23.1±3.6%，DCM患者为-15.1±5.1%（P=0.001）。GLS与MR评估的总瘢痕负荷密切相关（r=0.64，P<0.001）。随访时，患者被分为CRT治疗反应者（n=30；66.7%）和无反应者（n=15；33.3%）。无反应者的GLS与反应者相比有显著差异（无反应者的GLS：-10.4±5.1，反应者为-18.4±14%，P<0.001）。在多变量分析中，GLS（P<0.0001）和心室内径向不同步（P<0.001）是CRT治疗反应的有力独立决定因素。
GLS与MR评估的总瘢痕负荷密切相关，是CRT治疗反应的优秀独立预测指标。
