多层螺旋 CT 容积测量评估心脏再同步化治疗后逆向重构的潜能。

The potential of multi-slice computed tomography based volumetry for demonstrating reverse remodeling induced by cardiac resynchronization therapy.

机构信息

Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany.

出版信息

Comput Med Imaging Graph. 2010 Jul;34(5):388-93. doi: 10.1016/j.compmedimag.2010.01.002. Epub 2010 Feb 18.

DOI:10.1016/j.compmedimag.2010.01.002

PMID:20171056

Abstract

BACKGROUND

Multi-slice computed tomography (MSCT) was proved to provide precise cardiac volumetric assessment. Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure and reduced ejection fraction (HFREF). In HFREF patients we investigated the potential of MSCT based wall motion analysis in order to demonstrate CRT-induced reversed remodeling.

METHODS

Besides six patients with normal cardiac pump function serving as control group seven HFREF patients underwent contrast enhanced MSCT before and after CRT. Short cardiac axis views of the left ventricle (LV) in end-diastole (ED) and end-systole (ES) served for planimetry. Pre- and post-CRT MSCT based volumetry was compared with 2D echo. To demonstrate CRT-induced reverse remodeling, MSCT based multi-segment color-coded polar maps were introduced.

RESULTS

With regard to the HFREF patients pre-CRT MSCT based volumetry correlated with 2D echo data for LV-EDV (MSCT 278.3+/-75.0mL vs. echo 274.4+/-85.6mL) r=0.380, p=0.401, LV-ESV (MSCT 226.7+/-75.4mL vs. echo 220.1+/-74.0mL) r=0.323, p=0.479 and LV-EF (MSCT 20.2+/-8.8% vs. echo 20.0+/-11.9%) r=0.617, p=0.143. Post-CRT MSCT correlated well with 2D echo: LV-EDV (MSCT 218.9+/-106.4mL vs. echo 188.7+/-93.1mL) r=0.87, p=0.011, LV-ESV (MSCT 145+/-71.5mL vs. echo 125.6+/-78mL) r=0.84, p=0.018 and LV-EF (MSCT 29.6+/-11.3mL vs. echo 38.6+/-14.6mL) r=0.89, p=0.007. There was a significant increase of the mid-ventricular septum in terms of absolute LV wall thickening of the responders (pre 0.9+/-2.1mm vs. post 3.3+/-2.2mm; p<0.0005).

CONCLUSION

MSCT based volumetry involving multi-segment color-coded polar maps offers wall motion analysis to demonstrate CRT-induced reverse remodeling which needs to be further validated.

摘要

背景

多层螺旋 CT（MSCT）已被证明可提供精确的心脏容积评估。心脏再同步治疗（CRT）是一种有效的治疗方法，适用于部分射血分数降低的心力衰竭（HFREF）患者。在 HFREF 患者中，我们研究了基于 MSCT 的壁运动分析在证明 CRT 诱导的逆向重构中的潜力。

方法

除了 6 名心泵功能正常的患者作为对照组外，还有 7 名 HFREF 患者在 CRT 前后接受了对比增强 MSCT。舒张末期（ED）和收缩末期（ES）的左心室（LV）短轴视图用于作图。比较 CRT 前后的基于 MSCT 的容积测量值与二维超声心动图。为了证明 CRT 诱导的逆向重构，引入了基于 MSCT 的多节段彩色编码极图。

结果

对于 HFREF 患者，CRT 前的基于 MSCT 的容积测量值与二维超声心动图数据相关：LV-EDV（MSCT 278.3+/-75.0mL 与 echo 274.4+/-85.6mL）r=0.380，p=0.401，LV-ESV（MSCT 226.7+/-75.4mL 与 echo 220.1+/-74.0mL）r=0.323，p=0.479 和 LV-EF（MSCT 20.2+/-8.8%与 echo 20.0+/-11.9%）r=0.617，p=0.143。CRT 后 MSCT 与二维超声心动图密切相关：LV-EDV（MSCT 218.9+/-106.4mL 与 echo 188.7+/-93.1mL）r=0.87，p=0.011，LV-ESV（MSCT 145+/-71.5mL 与 echo 125.6+/-78mL）r=0.84，p=0.018 和 LV-EF（MSCT 29.6+/-11.3mL 与 echo 38.6+/-14.6mL）r=0.89，p=0.007。反应者的中隔绝对 LV 壁增厚显示出明显的中段室间隔增厚（CRT 前 0.9+/-2.1mm 与 CRT 后 3.3+/-2.2mm；p<0.0005）。