Zakhama Lilia, Neffati Sana, Boussabeh Elhem, Boukhris Besma, Saad Rim, Jendoubi Ali, Bennour Emna, BenYoussef Soraya
Service de Cardiologie. Hôpital des Forces de Sécurité Intérieure, La Marsa.
Tunis Med. 2010 Apr;88(4):234-9.
Echocardiographic parameters of mechanical dyssynchrony may improve patients selection for cardiac resynchronisation therapy in chronic heart failure.
This study aimed to define the prevalence of inter, intra and atrio-ventricular dyssynchrony in heart failure patients with different QRS duration and to evaluate inter and intra-observer variability in collecting different echocardiographic dyssynchony parameters.
Twenty patients with chronic heart failure of any origin, NYHA functional class II-III with LVEF < 40%, were evaluated by complete echocardiographic examination including tissue Doppler imaging (DTI) and Tissue Tracking.
Three patients had an atrio-ventricular dyssynchrony with a mean left ventricular filling time to cardiac cycle of 33 +/- 5%. Six patients had an interventricular mechanical delay (IVMD) > or = 40 milliseconds, all of them had a QRS duration > or = 120 milliseconds. Overall, no statistically significant correlation was found between IVMD and QRS duration (r = 0.35, p = 0.4). The mean septal to posterior wall-motion delay (SPWMD) was 83 +/- 64 ms. 7 patients had SPWMD > or = 130 ms. The baseline QRS duration did not correlate with SPWMD (p = 0.7). The mean LV dyssynchrony determined by deltaS-peak was 74 +/- 42 ms. Seven patients had LV dyssynchrony. Linear regression did not demonstrate a relation between QRS width and intraventricular dyssynchrony (p = 0.34). There was no concordance between intra-ventricular spatial or longitudinal dyssynchrony determined by DTI method and by Tissue Tracking (p = 0.3 and 0.6 respectively). The intraobserver reproducibility of LVFT/RR, IVMD and deltaS-peak (ICC = 0.99, 0.98 and 0.99, respectively), as well as the interobserver reproducibility (ICC: 0.96, 0.94 and 0.92, respectively), were very high. However, we observed a high variability for SPWMD measure (ICC = 0.27, p = 0.31).
Mechanical dyssynchrony did not correlate with QRS duration, despite the poor variability in collecting different echocardiographic parameters.
机械性不同步的超声心动图参数可能有助于改善慢性心力衰竭患者心脏再同步治疗的患者选择。
本研究旨在确定不同QRS时限的心力衰竭患者的房室间、心室内和房室不同步的患病率，并评估收集不同超声心动图不同步参数时观察者间和观察者内的变异性。
对20例任何病因的慢性心力衰竭患者进行评估，这些患者纽约心脏协会（NYHA）心功能分级为II-III级，左心室射血分数（LVEF）<40%，接受包括组织多普勒成像（DTI）和组织追踪的完整超声心动图检查。
3例患者存在房室不同步，左心室充盈时间与心动周期的平均比值为33±5%。6例患者存在心室间机械延迟（IVMD）≥40毫秒，他们的QRS时限均≥120毫秒。总体而言，IVMD与QRS时限之间未发现统计学上的显著相关性（r=0.35，p=0.4）。室间隔与后壁运动延迟（SPWMD）的平均值为83±64毫秒。7例患者的SPWMD≥130毫秒。基线QRS时限与SPWMD无相关性（p=0.7）。由deltaS-峰值确定的左心室不同步平均值为74±42毫秒。7例患者存在左心室不同步。线性回归未显示QRS宽度与心室内不同步之间的关系（p=0.34）。DTI方法和组织追踪确定的心室内空间或纵向不同步之间无一致性（分别为p=0.3和0.6）。左心室充盈时间/心动周期（LVFT/RR）、IVMD和deltaS-峰值的观察者内重复性（ICC分别为0.99、0.98和0.99）以及观察者间重复性（ICC分别为0.96、0.94和0.92）都非常高。然而，我们观察到SPWMD测量的变异性很大（ICC=0.27，p=0.31）。
尽管收集不同超声心动图参数时变异性较差，但机械性不同步与QRS时限无关。
