充血性心力衰竭时心室不同步模式——与对照组比较及对心脏再同步治疗患者选择的意义

Patterns of ventricular dyssynchrony in congestive heart failure- comparison with controls and implications for patient selection for cardiac resynchronization therapy.

作者信息

Hygriv Rao B, Raghu K, Sharada K, Anjineyulu A V, Narasimhan C, Somaraju B

机构信息

Department of Cardiology, CARE Hospitals and CARE Foundation, Hyderabad, Andhra Pradesh, India.

出版信息

Indian Heart J. 2010 Jul-Aug;62(4):308-12.

PMID:21280469

Abstract

BACKGROUND

Assessment of ventricular dyssynchrony by Tissue Doppler Imaging (TDI) is being increasingly used in patient selection for Cardiac Resynchronization Therapy (CRT). Regional distribution of dyssynchrony has been sparingly addressed in dyssynchrony studies in heart failure population.

METHODS

TDI was used to assess prevalence and regional distribution patterns of ventricular dyssynchrony in heart failure (HF) patients with systolic LVdysfunction (LVEF equal or less than 40%) in sinus rhythm. Inter-ventricular dyssynchrony (IVD) and left ventricular dyssynchrony (LVD) equal or greater than 40 msec were considered significant and LVD equal or greater than 65 m sec indicated severe dyssynchrony.

RESULTS

100 HF patients (Wide QRS, Gp I, N =70 & Normal QRS Gp II, N=30, and 25 normal individuals with complete LBBB (n=14) or RBBB (n=11) underwent TDI. IVD was seen in 35 (35%) patients (74% LV delay & 26% RV delay) and LVD in 68 patients (68%). The relative prevalence of lVD and LVD respectively in Group land Group II HF patients was47% vs. 7% (p < 0.001) and 70% vs. 67%. (p=ns) while LVD in Groups A (LBBB, n=41) & B (RBBB, n=26) was 76% and 58%, p=ns. The prevalence ofsevere LVD was similar in Gp I & II (37% and 57%, p=ns), and in Gp A & B (46% & 26%, p=ns). Regional distribution patterns of LVD in normal individuals with bundle branch block showed septal delay in 20%, a prevalence of similar to heart failure population (23%, Gp I, and 21% Gp II, p=ns). Lateral wall delay was demonstrated only in the HF population seen in 33% of Gp I and 47% of Gp II patients, p=ns.

CONCLUSIONS

LVD is distributed amongst HF patients with narrow or wide QRS and with LBBB or RBBB with a similar regional distribution. Dyssynchrony in normal individuals with bundle branch block is in the form of septal delay. These findings may have implications for patient selection for CRT and site of LV pacing.

摘要

背景

组织多普勒成像（TDI）对心室不同步的评估在心脏再同步治疗（CRT）患者选择中应用越来越广泛。心力衰竭人群不同步研究中，对不同步的区域分布关注较少。

方法

采用TDI评估窦性心律下收缩性左心室功能不全（左心室射血分数[LVEF]等于或小于40%）的心力衰竭（HF）患者心室不同步的患病率和区域分布模式。心室间不同步（IVD）和左心室不同步（LVD）等于或大于40毫秒被视为显著不同步，LVD等于或大于65毫秒提示严重不同步。

结果

100例HF患者（宽QRS波群，I组，N = 70；正常QRS波群，II组，N = 30）以及25例患有完全性左束支传导阻滞（n = 14）或右束支传导阻滞（n = 11）的正常个体接受了TDI检查。35例（35%）患者存在IVD（左心室延迟占74%，右心室延迟占26%），68例患者存在LVD（68%）。I组和II组HF患者中IVD和LVD的相对患病率分别为47%对7%（p < 0.001）和70%对67%（p = 无统计学意义），而A组（左束支传导阻滞，n = 41）和B组（右束支传导阻滞，n = 26）中LVD分别为76%和58%，p = 无统计学意义。I组和II组中严重LVD的患病率相似（37%和57%，p = 无统计学意义），A组和B组中分别为46%和26%，p = 无统计学意义。束支传导阻滞正常个体中LVD的区域分布模式显示，20%存在间隔延迟，患病率与心力衰竭人群相似（I组为23%，II组为21%，p = 无统计学意义）。仅在HF人群中发现侧壁延迟，I组33%的患者和II组47%的患者存在侧壁延迟，p = 无统计学意义。