Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
Eur J Heart Fail. 2011 Feb;13(2):186-94. doi: 10.1093/eurjhf/hfq197. Epub 2010 Nov 23.
The aim of this study was to investigate (i) the baseline patterns of segmental peak myocardial strain (PMS) in heart failure (HF) patients with ventricular conduction delay, (ii) changes in patterns of segmental PMS induced by cardiac resynchronization therapy (CRT), and (iii) whether they differ between CRT responders and non-responders.
Segmental and global longitudinal (L-) and radial (R-) PMS measurements derived from speckle tracking were prospectively obtained in 85 HF patients with intraventricular conduction delay before and 6 months after CRT device implantation and in 30 healthy subjects. Segmental strain analysis in HF patients showed pronounced heterogeneity both in longitudinal and in radial directions with the lowest amplitudes in the septum and the highest amplitudes in the lateral and posterior walls. After CRT, 60% of the patients were responders (≥ 15% reduction in end-systolic volume). Before CRT, responders showed higher global R-PMS than non-responders (19.5 ± 13.4 vs.13.1 ± 4.8%, respectively; P = 0.04) despite similar global L-PMS. After CRT, responders showed an increase in L-PMS in most segments and a homogeneous increase in R-PMS, leading to a more uniform pattern of strain and an improved global L-PMS and R-PMS. In contrast, in non-responders, the gain in L-PMS and R-PMS in septal segments was completely offset by a decrease in posterolateral segments, failing to decrease segmental heterogeneity and to increase global L-PMS and R-PMS.
Heart failure patients with ventricular conduction delay show pronounced heterogeneous patterns of segmental PMS, which can be reversed by CRT.
本研究旨在：(i) 探讨伴有心室传导延迟的心力衰竭（HF）患者节段峰值心肌应变（PMS）的基线模式；(ii) 心脏再同步治疗（CRT）诱导的节段 PMS 模式变化；(iii) 这些变化在 CRT 反应者和非反应者之间是否存在差异。
前瞻性地从斑点追踪中获取 85 例伴有室内传导延迟的 HF 患者 CRT 装置植入前和植入后 6 个月的节段和整体纵向（L-）和径向（R-）PMS 测量值，并获取 30 例健康受试者的相应值。HF 患者的节段应变分析显示，在纵向和径向方向上均存在明显的异质性，中隔的幅度最低，外侧壁和后壁的幅度最高。在 CRT 后，60%的患者为反应者（舒张末期容积减少≥15%）。在 CRT 前，反应者的整体 R-PMS 高于非反应者（分别为 19.5 ± 13.4%和 13.1 ± 4.8%；P = 0.04），尽管整体 L-PMS 相似。在 CRT 后，反应者的大多数节段 L-PMS 增加，R-PMS 均匀增加，导致应变模式更加均匀，整体 L-PMS 和 R-PMS 得到改善。相比之下，在非反应者中，室间隔节段的 L-PMS 和 R-PMS 增加完全被后外侧节段的减少所抵消，无法降低节段异质性，也无法增加整体 L-PMS 和 R-PMS。
伴有心室传导延迟的心力衰竭患者表现出明显的节段 PMS 异质性模式，这种模式可被 CRT 逆转。
