Deplagne Antoine, Bordachar Pierre, Reant Patricia, Montaudon Michel, Reuter Sylvain, Laborderie Julien, Dos Santos Pierre, Roudaut Raymond, Jais Pierre, Haissaguerre Michel, Laurent François, Clementy Jacques, Lafitte Stéphane
CHU of Bordeaux, Bordeaux, France.
Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):497-508. doi: 10.1016/j.acvd.2009.03.013. Epub 2009 Jun 21.
There is no gold standard technique for quantification of ventricular dyssynchrony.
To investigate whether additional real-time three-dimensional morphologic assessment of ventricular dyssynchrony affects response after biventricular pacing.
Forty-one patients with severe heart failure were implanted with a biventricular pacing device and underwent two-dimensional (time dispersion of 12 left ventricular electromechanical delays) and three-dimensional echocardiographic assessment of ventricular dyssynchrony (dispersion of time to minimum regional volume for 16 left ventricular segments), before implantation, 2 days postimplantation with optimization of the pacing interventricular delay and 6 months postimplantation.
Individual optimization of sequential biventricular pacing based on three-dimensional ventricular dyssynchrony provided more improvement (p<0.05) in left ventricular ejection fraction and cardiac output than simultaneous biventricular pacing. During the different configurations of sequential biventricular pacing, the changes in three-dimensional ventricular dyssynchrony were highly correlated with those of cardiac output (r=-0.67, p<0.001) and ejection fraction (r=-0.68, p<0.001). The correlations between two-dimensional ventricular dyssynchrony and cardiac output or ejection fraction were significant but less (r=-0.60, p<0.01 and r=-0.56, p<0.05, respectively). After 6 months, 76% of patients were considered responders (10% decrease in end-systolic volume). Before implantation, we observed a significant difference between responders and non-responders in terms of three-dimensional (p<0.05) - but not two-dimensional - ventricular dyssynchrony.
This prospective study demonstrated the additional value of three-dimensional assessment of ventricular dyssynchrony in predicting response after biventricular pacing and optimizing the pacing configuration.
目前尚无用于量化心室不同步的金标准技术。
研究心室不同步的额外实时三维形态学评估是否会影响双心室起搏后的反应。
41例重度心力衰竭患者植入双心室起搏装置，并在植入前、植入后2天优化心室起搏间期时以及植入后6个月接受二维（12个左心室机电延迟的时间离散度）和三维超声心动图评估心室不同步（16个左心室节段达到最小区域容积的时间离散度）。
基于三维心室不同步对序贯双心室起搏进行个体化优化，与同步双心室起搏相比，左心室射血分数和心输出量有更大改善（p<0.05）。在序贯双心室起搏的不同配置期间，三维心室不同步的变化与心输出量（r=-0.67，p<0.001）和射血分数（r=-0.68，p<0.001）的变化高度相关。二维心室不同步与心输出量或射血分数之间的相关性显著但较弱（分别为r=-0.60，p<0.01和r=-0.56，p<0.05）。6个月后，76%的患者被视为反应者（收缩末期容积减少10%）。植入前，我们观察到反应者和非反应者在三维（p<0.05）而非二维心室不同步方面存在显著差异。
这项前瞻性研究证明了心室不同步的三维评估在预测双心室起搏后的反应和优化起搏配置方面的额外价值。
