Phillips Karen P, Popović Zoran B, Lim Pascal, Meulet John E, Barrett Conor D, Di Biase Luigi, Agler Deborah, Thomas James D, Grimm Richard A
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
JACC Cardiovasc Imaging. 2009 Apr;2(4):379-86. doi: 10.1016/j.jcmg.2008.12.022.
This study sought to assess whether longitudinal rotation (LR) affects myocardial systolic velocity profiles and to compare velocity-based measures of dyssynchrony with LR for predicting cardiac resynchronization therapy (CRT) response.
Longitudinal rotation, a rocking motion often seen when the dilated left ventricle (LV) is imaged in its horizontal long-axis plane, is a recently recognized phenomenon and a new predictor of response to CRT.
One hundred patients with CRT implants and suitable baseline echocardiograms were identified. Longitudinal rotation was assessed in the apical 4-chamber view by speckle-tracking techniques and myocardial systolic velocities for basal septum, and lateral LV were analyzed from tissue Doppler images. The quartiles of LR distribution were analyzed for differences in their systolic velocities. Correlation between measurements and reduction in LV end-systolic volume (ESV) at follow-up was performed.
Quartile 1 had a mean LR of -6.8 +/- 2.3 degrees ; quartile 4 showed a mean LR of 2.3 +/- 1.6 degrees . A depressed peak velocity of lateral wall, when compared with the septum, was found for quartile 1 (p = 0.01), whereas the converse was noted in quartile 4 (p = 0.0001). The difference in amplitude of peak velocity between septal and lateral walls was found to correlate with the pattern of LR and with percentage reduction in LV ESV at follow-up in nonischemic patients. Septal-lateral delay was not correlated with the presence of LR, nor was it predictive of reduction in LV ESV.
Patients with prominent clockwise LR have depressed long-axis systolic velocities of the lateral wall, whereas the patients with counterclockwise LR have depressed septal wall velocities. The difference in peak amplitude of basal septal and lateral systolic velocities is predictive of LR, and in the nonischemic subgroup correlates with quantitative LV reverse remodeling at follow-up. Velocity time-based measures, including septal-lateral delay were not predictive of CRT response.
本研究旨在评估纵向旋转（LR）是否会影响心肌收缩速度剖面图，并比较基于速度的不同步测量指标与LR对心脏再同步治疗（CRT）反应的预测能力。
纵向旋转是一种在扩张的左心室（LV）水平长轴平面成像时常见的摆动运动，是一种最近才被认识到的现象，也是CRT反应的一种新预测指标。
确定了100例植入CRT且有合适基线超声心动图的患者。通过斑点追踪技术在心尖四腔视图中评估纵向旋转，并从组织多普勒图像分析基底间隔和左心室侧壁的心肌收缩速度。分析LR分布的四分位数在收缩速度方面的差异。进行测量指标与随访时左心室收缩末期容积（ESV）减少之间的相关性分析。
第一四分位数的平均LR为-6.8±2.3度；第四四分位数的平均LR为2.3±1.6度。与间隔相比，第一四分位数的侧壁峰值速度降低（p = 0.01），而在第四四分位数中则相反（p = 0.0001）。发现间隔和侧壁之间峰值速度幅度的差异与LR模式以及非缺血性患者随访时左心室ESV的减少百分比相关。间隔-侧壁延迟与LR的存在无关，也不能预测左心室ESV的减少。
顺时针LR明显的患者侧壁长轴收缩速度降低，而逆时针LR的患者间隔壁速度降低。基底间隔和侧壁收缩速度峰值幅度的差异可预测LR，在非缺血亚组中与随访时左心室的定量逆向重构相关。基于速度时间的测量指标，包括间隔-侧壁延迟，不能预测CRT反应。
