多平面心肌不同步在心脏再同步治疗中的应用。
Multi-plane mechanical dyssynchrony in cardiac resynchronization therapy.
机构信息
Department of Research, St. Paul Heart Clinic, St. Paul, Minnesota 55102, USA.
出版信息
Clin Cardiol. 2010 Feb;33(2):E31-8. doi: 10.1002/clc.20529.
BACKGROUND
The aims of this study were to assess the ability of several echo measures of dyssynchrony to predict CRT response and to characterize the global effect of CRT.
HYPOTHESIS
We hypothesized that after CRT there would be significant reductions in mechanical dyssynchrony in all 3 orthogonal planes of cardiac motion and that those patients with significant dyssynchrony prior to implant would have the best echocardiographic response.
METHODS
Standard echocardiograms were performed pre-CRT and post-CRT (138 +/- 63d) in 70 heart failure patients. Longitudinal dyssynchrony was calculated as the standard deviation (SD) of time to peak systolic displacement and velocity of 12 segments from 3 apical views. Using midventricular short axis views and speckle-tracking methods, the SD of time to peak radial and circumferential strain in 6 segments were calculated. Cardiac resynchronization therapy echo response was defined as > or = 15% decrease in left ventricular end-systolic volume.
RESULTS
Cardiac resynchronization therapy significantly improved systolic function in the longitudinal, radial, and circumferential planes. The CRT echo response rate was 57%. Echo responders (CRT(R)) had significantly (P < .05) more dyssynchrony at baseline as compared to nonresponders (CRT(NR)). Cardiac resynchronization therapy significantly (P < .05) reduced longitudinal and radial, but not circumferential, dyssynchrony in CRT(R). Dyssynchrony was unchanged in CRT(NR). Receiver-operator characteristic (ROC) curve analysis indicated significant, but modest sensitivity and specificity for longitudinal and radial intraventricular dyssynchrony and for interventricular dyssynchrony. Combining radial and longitudinal dyssynchrony measures improved positive prediction of CRT response.
CONCLUSIONS
Cardiac resynchronization therapy improves left ventricular function in 3 orthogonal planes of motion. Longitudinal, radial, and interventricular dyssynchrony modestly predict reverse remodeling.
背景
本研究旨在评估几种不同的心脏失同步指标预测 CRT 反应的能力，并对 CRT 的整体效果进行特征描述。
假设
我们假设 CRT 后，所有 3 个心脏运动正交平面的机械失同步将显著减少，并且那些在植入前存在明显失同步的患者将具有最佳的超声心动图反应。
方法
在 70 例心力衰竭患者中，分别在 CRT 前（CRT 前）和 CRT 后（138 ± 63d）进行标准超声心动图检查。纵向失同步通过从 3 个心尖视图的 12 个节段计算收缩期位移和速度的峰值时间的标准差（SD）来计算。使用中室短轴视图和斑点跟踪方法，计算 6 个节段的峰值径向和周向应变的 SD。心脏再同步治疗超声心动图反应定义为左心室收缩末期容积减少>或= 15%。
结果
CRT 在纵向、径向和周向平面显著改善了收缩功能。CRT 超声心动图反应率为 57%。与无反应者（CRT（NR））相比，反应者（CRT（R））在基线时的失同步明显更多（P <.05）。CRT（R）的纵向和径向但不是周向的失同步在 CRT 后显著（P <.05）减少。CRT（NR）的失同步无变化。ROC 曲线分析表明，纵向和径向室内失同步以及室间失同步具有显著但适度的敏感性和特异性。结合径向和纵向失同步指标可提高 CRT 反应的阳性预测率。
结论
CRT 改善了 3 个运动正交平面的左心室功能。纵向、径向和室间失同步可适度预测逆重构。
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