Dreger Henryk, Borges Adrian C, Ismer Bruno, Schattke Sebastian, Stegemann Berthold, Baumann Gert, Melzer Christoph
Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Germany.
Cardiovasc Ultrasound. 2009 Sep 25;7:46. doi: 10.1186/1476-7120-7-46.
Established methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT). Thus, there is a need for easy and robust approaches to reliably assess cardiac asynchrony.
We performed echocardiography in 100 healthy subjects and 33 patients with left bundle branch block (LBBB). To detect intraventricular asynchrony, we combined two established methods, i.e., tissue synchronization imaging (TSI) and tissue Doppler imaging (TDI). The time intervals from the onset of aortic valve opening (AVO) to the peak systolic velocity (S') were measured separately in six basal segments in the apical four-, two-, and three-chamber view. Color-coded TSI served as an intrinsic plausibility control and helped to identify the correct S' measuring point in the TDI curves. Next, we identified the segment with the shortest AVO-S' interval. Since this segment most likely represents vital and intact myocardium it served as a reference for other segments. Segments were considered asynchronous when the delay between the segment in question and the reference segment was above the upper limit of normal delays derived from the control population. Intra- and interobserver variability were 7.0% and 7.7%, respectively.
Our results suggest that combination of TDI and TSI with intrinsic plausibility control improves intra- and interobserver variability and allows easy and reliable assessment of cardiac asynchrony.
已有的确定不同步性的方法存在较高的观察者内和观察者间变异性，且未能改善心脏再同步治疗（CRT）的患者选择。因此，需要简便且可靠的方法来可靠地评估心脏不同步性。
我们对100名健康受试者和33名左束支传导阻滞（LBBB）患者进行了超声心动图检查。为检测心室内不同步性，我们结合了两种已有的方法，即组织同步成像（TSI）和组织多普勒成像（TDI）。在经胸超声心动图的心尖四腔、两腔和三腔视图中，分别测量从主动脉瓣开放（AVO）开始到收缩期峰值速度（S'）的时间间隔。彩色编码的TSI作为内在的合理性对照，有助于在TDI曲线上识别正确的S'测量点。接下来，我们确定AVO-S'间隔最短的节段。由于该节段最可能代表有活力且完整的心肌组织，因此将其作为其他节段的参考。当所讨论的节段与参考节段之间的延迟高于来自对照人群的正常延迟上限时，这些节段被视为不同步。观察者内和观察者间变异性分别为7.
