Department of Cardiology, Second University of Naples, Naples, Italy.
Eur J Heart Fail. 2009 Dec;11(12):1169-77. doi: 10.1093/eurjhf/hfp158.
To evaluate right atrial (RA) morphology and deformation in patients with dilated cardiomyopathy (DCM).
A total of 130 patients with either idiopathic (n = 70) or ischaemic (n = 60) DCM, and 60 controls underwent clinical examination, standard echocardiography, and RA two-dimensional strain echocardiography (2DSE). Six months after implantation of a cardiac resynchronization therapy (CRT) device, the DCM patients were re-evaluated, if their left ventricular (LV) end-systolic volume had decreased by at least 15% they were defined as echocardiographic responders. All DCM patients were in NYHA class III before CRT, with a mean LV ejection fraction of 29.2 +/- 5.5%. After CRT, 94 patients were in NYHA functional class I-II. The patients were subdivided into echocardiographic responders (n = 85) and non-responders (n = 45). Both RA area index (19.7 +/- 5.5 cm(2)/m in non-responders vs. 13.2 +/- 4.4 cm(2)/m in responders; P < 0.001) and RA strain of lateral wall (24.3 +/- 10.2% in non-responders vs. 40.2 +/- 8.9% in responders; P < 0.001) were significantly different between the two groups. A RA area index >or=16 cm(2)/m showed a sensitivity and specificity of 87.1 and 95.4%, respectively (P < 0.0001) to predict a negative response to CRT. By multivariable analysis, increased RA area index (P < 0.001), ischaemic aetiology of DCM (P < 0.01), and less severe radial intraventricular dyssynchrony were independent determinants of an unfavourable response to CRT.
Right atrial area index was increased and RA myocardial deformation was impaired in patients with DCM who were non-responders to CRT.
评估扩张型心肌病（DCM）患者的右心房（RA）形态和变形。
共纳入 130 例特发性（n=70）或缺血性（n=60）DCM 患者和 60 例对照者，进行临床检查、标准超声心动图和 RA 二维应变成像（2DSE）检查。在植入心脏再同步治疗（CRT）装置 6 个月后，如果 DCM 患者的左心室（LV）收缩末期容积至少降低 15%，则重新评估其为超声心动图应答者。所有 DCM 患者在 CRT 前均为纽约心脏协会（NYHA）心功能 III 级，平均 LV 射血分数为 29.2±5.5%。在 CRT 后，94 例患者的 NYHA 心功能分级为 I-II 级。将患者分为超声心动图应答者（n=85）和无应答者（n=45）。两组患者的 RA 面积指数（无应答者为 19.7±5.5cm2/m，应答者为 13.2±4.4cm2/m；P<0.001）和 RA 侧壁应变（无应答者为 24.3±10.2%，应答者为 40.2±8.9%；P<0.001）均有显著差异。RA 面积指数>or=16cm2/m 对预测 CRT 无反应的敏感性和特异性分别为 87.1%和 95.4%（P<0.0001）。多变量分析显示，RA 面积指数增加（P<0.001）、DCM 的缺血性病因（P<0.01）和径向室内不同步程度较轻是 CRT 无反应的独立决定因素。
CRT 无反应的 DCM 患者的右心房面积指数增加，RA 心肌变形受损。
