Soliman Osama I I, Geleijnse Marcel L, Theuns Dominic A M J, van Dalen Bas M, Vletter Wim B, Jordaens Luc J, Metawei Ahmed K, Al-Amin Aly M, ten Cate Folkert J
Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2009 Jun 1;103(11):1586-91. doi: 10.1016/j.amjcard.2009.01.372. Epub 2009 Apr 8.
Real-time 3-dimensional echocardiography (RT3DE) allows simultaneous timing of regional volumetric changes as a net result of longitudinal, radial, circumferential left ventricular (LV) contraction, hence LV systolic dyssynchrony. We sought to examine real-time 3-dimensional echocardiographically derived dyssynchrony for prediction of long-term response to cardiac resynchronization therapy (CRT) in a prospective study. Ninety consecutive patients with heart failure (mean age 60 +/- 12 years, 73% men, New York Heart Association class III in 97%) underwent clinical and echocardiographic assessments at baseline and at 12 months after CRT including real-time 3-dimensional echocardiographically derived LV systolic dyssynchrony index. The systolic dyssynchrony index (SDI) was defined as the SD of time to minimum systolic volume of the 16 LV segments, expressed in percent RR duration. CRT response was defined as a >15% decrease in LV end-systolic volume on real-time 3-dimensional echocardiogram. After 12 months of CRT, 68 patients (76%) were responders. Feasibility of the SDI was 94%. An SDI >10% predicted CRT response with good sensitivity (96%), specificity (88%), positive likelihood ratio (8), and negative likelihood ratio (0.05). Patients with an SDI >10% had mean change (-21%, -31%, 39% vs -13%, -10%, 10%) in LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction, respectively, compared with baseline versus patients with an SDI <10% (p <0.01). Mean acquisition and analysis duration of single-patient RT3DE was 8 minutes (range 6 to 13). Interobserver variabilities of LV end-systolic volume and SDI were 5% and 11%, respectively. In conclusion, RT3DE provides accurate identification of reverse volumetric LV remodeling after CRT. From these accurate volumetric data, RT3DE provides more intuitive assessment of dyssynchrony and response to CRT as a simple, reproducible, and fast technique. CRT can be individually tailored using RT3DE and seems very effective in patients with heat failure with real-time 3-dimensional echocardiographic evidence of dyssynchrony.
实时三维超声心动图（RT3DE）能够同步记录局部容积变化的时间，这些变化是左心室（LV）纵向、径向、圆周方向收缩的综合结果，即左心室收缩不同步。我们在一项前瞻性研究中，试图通过实时三维超声心动图检测不同步情况，以预测心脏再同步治疗（CRT）的长期疗效。连续90例心力衰竭患者（平均年龄60±12岁，男性占73%，97%为纽约心脏协会心功能Ⅲ级）在基线期以及CRT治疗后12个月接受了临床和超声心动图评估，包括通过实时三维超声心动图得出的左心室收缩不同步指数。收缩不同步指数（SDI）定义为16个左心室节段达到最小收缩容积的时间标准差，以RR间期的百分比表示。CRT反应定义为实时三维超声心动图显示左心室收缩末期容积减少>15%。CRT治疗12个月后，68例患者（76%）有反应。SDI的可行性为94%。SDI>10%预测CRT反应的敏感性良好（96%）、特异性（88%）、阳性似然比（8）和阴性似然比（0.05）。与SDI<10%的患者相比，SDI>10%的患者左心室舒张末期容积、左心室收缩末期容积和左心室射血分数与基线相比平均变化分别为（-21%，-31%，39% vs -13%，-10%，10%）（p<0.01）。单例患者RT3DE的平均采集和分析时间为8分钟（范围6至13分钟）。左心室收缩末期容积和SDI的观察者间变异性分别为5%和11%。总之，RT3DE能够准确识别CRT后左心室容积的逆向重塑。基于这些准确的容积数据，RT3DE作为一种简单、可重复且快速的技术，能更直观地评估不同步情况以及对CRT的反应。使用RT3DE可对CRT进行个体化调整，对于有实时三维超声心动图显示不同步的心力衰竭患者似乎非常有效。
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