The University of Melbourne, Austin Health and Northern Health, Melbourne, Australia.
Europace. 2011 Feb;13(2):270-6. doi: 10.1093/europace/euq442.
Cardiac resynchronization therapy is showing benefits for an increasing number of indications but fails to predict response in up to 20-30% of subjects. Echocardiographically assessed dyssynchrony has been proposed as a potential stratifier but current methods are time-consuming and suffer poor reproducibility, thus limiting their clinical utility. This study compared the accuracy, time efficiency, and reproducibility of automated tissue synchronization imaging (Auto TSI) vs. established manual tissue velocity imaging (TVI) techniques for the assessment of intra-ventricular dyssynchrony in sinus and non-sinus rhythm.
Fifty consecutive stable systolic heart failure patients on optimal guideline-based medical therapy underwent intra-ventricular dyssynchrony assessment [time to peak velocity (Ts), septal to lateral delay (SLD), and dyssynchrony index (DI)] with TVI and Auto TSI techniques, enabling the assessment of agreement, time efficiency, and reproducibility. Statistical analyses included Pearson's correlation, Bland-Altman's statistics, and coefficient of reproducibility. There was excellent agreement between Auto TSI and TVI for the measurement of Ts [r=0.92, P<0.001, limits of agreement (LOA): -27.3 to 56.5 ms], SLD (r=0.94, P<0.001, LOA: -41 to 49 ms), and DI (r=0.89, P<0.001, LOA: -12.2 to 12.6 ms) which persisted irrespective of cardiac rhythm [Ts: sinus (n=32) r=0.93, P<0.001; non-sinus (n=18) r=0.91, P<0.001]. Automated TSI was more time efficient (3±1 vs. 14±2 min, P<0.001) and demonstrated superior reproducibility: intra-observer (5.5 vs. 9.6%) and inter-observer variability (9.5 vs. 13.4%).
Automated TSI enables rapid, reproducible intra-ventricular dyssynchrony assessment and overcomes some of the limitations of conventional techniques in sinus and non-sinus rhythm.
心脏再同步治疗在越来越多的适应证中显示出益处，但在多达 20-30%的患者中无法预测反应。超声心动图评估的不同步已被提议作为一种潜在的分层因素，但目前的方法耗时且重复性差，因此限制了其临床应用。本研究比较了自动组织同步成像（Auto TSI）与传统组织速度成像（TVI）技术评估窦性和非窦性节律下心室内不同步的准确性、时间效率和可重复性。
50 例连续稳定的射血分数降低的心力衰竭患者接受了基于最佳指南的药物治疗，接受了 TVI 和 Auto TSI 技术评估心室内不同步[峰值速度时间（Ts）、间隔到侧壁延迟（SLD）和不同步指数（DI）]，以评估一致性、时间效率和可重复性。统计分析包括 Pearson 相关、Bland-Altman 统计和可重复性系数。Auto TSI 与 TVI 测量 Ts [r=0.92，P<0.001，一致性范围（LOA）：-27.3 至 56.5 ms]、SLD（r=0.94，P<0.001，LOA：-41 至 49 ms）和 DI（r=0.89，P<0.001，LOA：-12.2 至 12.6 ms）之间具有极好的一致性，无论心脏节律如何（Ts：窦性[ n=32] r=0.93，P<0.001；非窦性[ n=18] r=0.91，P<0.001]）。自动 TSI 更省时（3±1 分钟对 14±2 分钟，P<0.001），并表现出更好的可重复性：观察者内（5.5%对 9.6%）和观察者间变异性（9.5%对 13.4%）。
自动 TSI 可快速、可重复地评估心室内不同步，并克服了窦性和非窦性节律中传统技术的一些局限性。
