右心室指数预测心脏再同步治疗反应的增量价值。
The incremental value of right ventricular indices for predicting response to cardiac resynchronization therapy.
机构信息
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
出版信息
J Am Soc Echocardiogr. 2011 Feb;24(2):170-179.e3. doi: 10.1016/j.echo.2010.11.015. Epub 2010 Dec 21.
BACKGROUND
Right ventricular (RV) dysfunction in chronic heart failure (HF) is associated with poor prognosis. Cardiac resynchronization therapy (CRT) is an established method of improving prognosis in HF. However, the majority of known indices predictive of response to CRT are based on left ventricular (LV) assessment. The authors hypothesized that baseline RV function and tissue Doppler-derived dyssynchrony may have incremental value over LV dyssynchrony measures for predicting CRT response.
METHODS
In this retrospective study, echocardiographic examinations were performed in 90 patients before pacemaker implantation and up to 18 months afterward. CRT results were evaluated using clinical criteria (death, hospitalization for decompensation, change in New York Heart Association class ≥1, and 10% decreases in both peak ventilatory oxygen uptake and 6-min walking distance) and reverse remodeling (>15% reduction in LV end-systolic volume).
RESULTS
Baseline RV dyssynchrony during isovolumic contraction of 26 msec facilitated the segregation of responders from nonresponders with 85% sensitivity and 100% specificity, as well as synchrony in peak deformation of 54 msec, with 89% sensitivity and 67% specificity. The minor axis of the RV inflow tract predicted reverse remodeling after CRT with sensitivity of 73% and specificity of 58% with a cutoff value of 35 mm. According to the clinical criteria, LV indices (end-diastolic and end-systolic volumes) and interventricular delay gave an overall R(2) value of 0.20 (86.2% correctly classified patients; area under the curve, 0.80). The addition of RV dyssynchrony parameters (measured in peak strain and isovolumic contraction peak velocities) significantly increased the power of the model (R(2) = 0.86; 100% of patients correctly classified; area under the curve, 1; P for change in R(2) < .0001).
CONCLUSIONS
The value of baseline RV function analysis is incremental to LV indices for the prediction of clinical response to CRT but not reverse remodeling. RV synchronous longitudinal deformation and RV dyssynchronous isovolumic velocity are independent predictors of clinical response to CRT.
背景
慢性心力衰竭（HF）患者的右心室（RV）功能障碍与预后不良相关。心脏再同步治疗（CRT）是改善 HF 预后的一种既定方法。然而，大多数已知的 CRT 反应预测指标都是基于左心室（LV）评估的。作者假设，基线 RV 功能和组织多普勒衍生的不同步可能比 LV 不同步指标对预测 CRT 反应具有更大的价值。
方法
在这项回顾性研究中，对 90 例在起搏器植入前和之后 18 个月内进行了超声心动图检查。使用临床标准（死亡、因失代偿住院、纽约心脏协会分级增加≥1 级和峰值通气摄氧量和 6 分钟步行距离均下降 10%）和逆重构（LV 收缩末期容积减少>15%）评估 CRT 结果。
结果
等容收缩期 26 毫秒的基线 RV 不同步有助于将反应者与无反应者分开，敏感性为 85%，特异性为 100%，峰值变形 54 毫秒的同步性，敏感性为 89%，特异性为 67%。RV 流入道的小轴预测 CRT 后的逆重构，敏感性为 73%，特异性为 58%，截断值为 35mm。根据临床标准，LV 指标（舒张末期和收缩末期容积）和室间隔延迟给出的整体 R(2)值为 0.20（86.2%的患者分类正确；曲线下面积，0.80）。添加 RV 不同步参数（在峰值应变和等容收缩期峰值速度中测量）显著增加了模型的能力（R(2)=0.86；100%的患者分类正确；曲线下面积，1；P 值变化<.0001）。
结论
基线 RV 功能分析对预测 CRT 临床反应的价值优于 LV 指数，但对逆重构的预测价值不大。RV 同步纵向变形和 RV 不同步等容速度是 CRT 临床反应的独立预测因子。
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