超声心动图相位成像预测心脏再同步治疗后的逆向重构

Echocardiographic phase imaging to predict reverse remodeling after cardiac resynchronization therapy.

作者信息

Buss Sebastian J, Humpert Per M, Bekeredjian Raffi, Hardt Stefan E, Zugck Christian, Schellberg Dieter, Bauer Alexander, Filusch Arthur, Kuecherer Helmut, Katus Hugo A, Korosoglou Grigorios

机构信息

Department of Cardiology, University of Heidelberg, Heidelberg, Germany.

出版信息

JACC Cardiovasc Imaging. 2009 May;2(5):535-43. doi: 10.1016/j.jcmg.2009.03.003.

DOI:10.1016/j.jcmg.2009.03.003

PMID:19442937

Abstract

OBJECTIVES

The aim of our study was to investigate whether echocardiographic phase imaging (EPI) can predict response in patients who are considered for cardiac resynchronization therapy (CRT).

BACKGROUND

CRT improves quality of life, exercise capacity, and outcome in patients with bundle-branch block and advanced heart failure. Previous studies used QRS duration to select patients for CRT; the accuracy of this parameter to predict functional recovery, however, is controversial.

METHODS

We examined 42 patients with advanced heart failure (New York Heart Association [NYHA] functional class III to IV, QRS duration >130 ms, and ejection fraction <35%) before and 6 to 8 months after CRT. Left ventricular (LV) dyssynchrony was estimated by calculating the SD of time to peak velocities (Ts-SD) by conventional tissue Doppler imaging (TDI), and the mean phase index (mean EPI-Index) was calculated by EPI in 12 mid-ventricular and basal segments. Patients who were alive and had significant relative decrease in end-systolic LV volume of Delta ESV >or=15% at 6 to 8 months of follow-up were defined as responders. All others were classified as nonresponders.

RESULTS

The Ts-SD and the mean EPI-Index were related to Delta ESV (r = 0.43 for Ts-SD and r = 0.67 for mean EPI-Index, p < 0.01 for both), and both parameters yielded similar accuracy for the prediction of LV remodeling (area under the curve of 0.87 for TDI vs. 0.90 for EPI, difference between areas = 0.03, p = NS) and ejection fraction (EF) improvement (area under the curve of 0.87 for TDI vs. 0.93 for EPI, difference between areas = 0.06, p = NS). Furthermore, patients classified as responders by EPI (mean EPI-Index <or=59%) showed significant improvement in NYHA functional class and in 6-min walk test (409 +/- 88 m at follow-up vs. 312 +/- 86 m initially, p < 0.001).

CONCLUSION

Echocardiographic phase imaging can predict functional recovery, reverse LV remodeling, and clinical outcomes in patients who undergo CRT. EPI is a method that objectively and accurately quantifies LV dyssynchrony and seems to be noninferior to TDI for the prediction of reverse LV remodeling and functional recovery.

摘要

目的

我们研究的目的是调查超声心动图相位成像（EPI）能否预测拟接受心脏再同步治疗（CRT）患者的反应。

背景

CRT可改善束支传导阻滞和晚期心力衰竭患者的生活质量、运动能力及预后。既往研究使用QRS波时限来选择CRT治疗的患者；然而，该参数预测功能恢复的准确性存在争议。

方法

我们在CRT治疗前及治疗后6至8个月对42例晚期心力衰竭患者（纽约心脏协会[NYHA]心功能分级III至IV级、QRS波时限>130毫秒且射血分数<35%）进行了检查。通过传统组织多普勒成像（TDI）计算峰值速度时间标准差（Ts-SD）来评估左心室（LV）不同步，通过EPI计算12个心室中部和基底部节段的平均相位指数（平均EPI指数）。在随访6至8个月时存活且收缩末期LV容积相对显著减少（ΔESV≥15%）的患者被定义为反应者。所有其他患者分类为无反应者。

结果

Ts-SD和平均EPI指数均与ΔESV相关（Ts-SD的r = 0.43，平均EPI指数的r = 0.67，两者p均<0.01），且这两个参数在预测LV重构（TDI曲线下面积为0.87，EPI为0.90，面积差异 = 0.03，p = 无显著性差异）和射血分数（EF）改善（TDI曲线下面积为0.87，EPI为0.93，面积差异 = 0.06，p = 无显著性差异）方面具有相似的准确性。此外，根据EPI分类为反应者（平均EPI指数≤59%）的患者NYHA心功能分级和6分钟步行试验有显著改善（随访时为409±88米，初始时为312±86米，p<0.001）。