Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Chin Med J (Engl). 2013 Jul;126(14):2620-4.
The number of non-responders to cardiac resynchronization therapy (CRT) exposes the need for better patient selection criteria for CRT. This study aimed to identify echocardiographic parameters that would predict the response to CRT.
Forty-five consecutive patients receiving CRT-D implantation for heart failure (HF) were included in this prospective study. New York Heart Association (NYHA) class, 6-minute walk distance, electrograph character, and multi echocardiographic parameters, especially in strain patterns, were measured and compared before and six months after CRT in the responder and non-responder groups. Response to CRT was defined as a decrease in left ventricular endsystolic volume (LVESV) of 15% or more at 6-month follow up.
Twenty-two (48.9%) patients demonstrated a response to CRT at 6-month follow-up. Significant improvement in NYHA class (P < 0.01), left ventricular end-diastolic volume (LVEDV) (P < 0.01), and 6-minute walk distance (P < 0.01) was shown in this group. Although there was an interventricular mechanical delay determined by the difference between left and right ventricular pre-ejection intervals ((42.87 ± 19.64) ms vs. (29.43 ± 18.19) ms, P = 0.02), the standard deviation of time to peak myocardial strain among 12 basal, mid and apical segments (Tε-SD) ((119.97 ± 43.32) ms vs. (86.62 ± 36.86) ms, P = 0.01) and the non-ischemic etiology (P = 0.03) were significantly higher in responders than non-responders, only the Tε-SD (OR = 1.02, 95% CI = 1.01 - 1.04, P = 0.02) proved to be a favorable predictor of CRT response after multivariate Logistic regression analysis.
The left ventricular 12 segmental strain imaging is a promising echocardiographic parameter for predicting CRT response.
心脏再同步治疗（CRT）无应答者的数量表明需要更好的 CRT 患者选择标准。本研究旨在确定可预测 CRT 反应的超声心动图参数。
本前瞻性研究纳入了 45 例因心力衰竭（HF）接受 CRT-D 植入的连续患者。在 CRT 前后测量并比较了纽约心脏协会（NYHA）分级、6 分钟步行距离、心电图特征和多种超声心动图参数，特别是应变模式，并在应答者和无应答者组中进行了比较。CRT 反应定义为 6 个月随访时左心室收缩末期容积（LVESV）减少 15%或更多。
22 例（48.9%）患者在 6 个月随访时对 CRT 有反应。该组 NYHA 分级（P < 0.01）、左心室舒张末期容积（LVEDV）（P < 0.01）和 6 分钟步行距离（P < 0.01）显著改善。尽管左、右心室射血前期之间的间隔（LV 和 RV 预射间隔）差异决定的室间机械延迟（42.87 ± 19.64 ms 与 29.43 ± 18.19 ms，P = 0.02），12 个基底、中部和心尖节段的心肌应变峰值时间标准差（Tε-SD）（119.97 ± 43.32 ms 与 86.62 ± 36.86 ms，P = 0.01）和非缺血性病因（P = 0.03）在应答者中明显高于无应答者，但只有 Tε-SD（OR = 1.02，95%CI = 1.01 - 1.04，P = 0.02）经多变量 Logistic 回归分析后被证明是 CRT 反应的有利预测因子。
左心室 12 节段应变成像可能是预测 CRT 反应的有前途的超声心动图参数。
