Service de Cardiologie, CIC-IT INSERM U 642, CHU Rennes, Rennes, France.
J Am Soc Echocardiogr. 2009 Oct;22(10):1152-8. doi: 10.1016/j.echo.2009.06.005. Epub 2009 Aug 8.
Cardiac resynchronization therapy (CRT), which improves left ventricular (LV) function and reverses LV remodeling, is an established therapy for advanced heart failure with prolonged QRS duration. The aim of this study was to examine whether CRT improves atrial function and induces atrial reverse remodeling.
A total of 46 patients with heart failure (mean age, 66.7 +/- 10.4 years) who underwent CRT were evaluated with echocardiography before and after 6 months of optimized CRT. Atrial function and LV function were assessed with M-mode, two-dimensional echocardiography, Doppler, tissue Doppler velocity, and strain (epsilon) imaging. LV reverse remodeling was defined as a reduction in LV end-systolic volume of >15%.
In responders (n = 23), significant improvements in left atrial (LA) functional, structural, and anatomic remodeling were observed. Maximum LA area and volume decreased, the LA emptying fraction increased, A' increased, and LA epsilon increased from 25.6 +/- 11.0% to 42.6 +/- 10.4% (P < .05 overall). LA reverse remodeling was correlated with baseline LA volume (R = 0.45). Although the correlation was not significant (r = 0.24), LA reverse remodeling was also more frequent in patients with LV reverse remodeling.
In patients with LV remodeling, significant LA reverse remodeling after CRT could be observed and detailed on transthoracic echocardiography.
心脏再同步治疗（CRT）可改善左心室（LV）功能并逆转 LV 重构，是治疗 QRS 持续时间延长的晚期心力衰竭的一种既定疗法。本研究旨在探讨 CRT 是否可改善心房功能并引起心房逆重构。
共 46 例心力衰竭患者（平均年龄 66.7 ± 10.4 岁）接受 CRT 优化治疗 6 个月后接受超声心动图评估。使用 M 型、二维超声心动图、多普勒、组织多普勒速度和应变（ε）成像评估心房功能和 LV 功能。LV 逆重构定义为 LV 收缩末期容积减少 >15%。
在应答者（n=23）中，观察到左心房（LA）功能、结构和解剖重构的显著改善。最大 LA 面积和容量减小，LA 排空分数增加，A'增加，LA ε从 25.6±11.0%增加至 42.6±10.4%（总体 P<.05）。LA 逆重构与基线 LA 容积呈相关（R=0.45）。尽管相关性不显著（r=0.24），但在 LV 逆重构患者中，LA 逆重构也更为常见。
在 LV 重构患者中，可在 CRT 后观察到并经胸超声心动图详细显示明显的 LA 逆重构。
