Department of Cardiovascular Medicine, Cleveland Clinic, OH.
Circ Cardiovasc Imaging. 2013 Nov;6(6):864-72. doi: 10.1161/CIRCIMAGING.112.000026. Epub 2013 Oct 1.
Studies of echocardiographic predictors of response after cardiac resynchronization therapy (CRT) have largely involved single parameters. We hypothesized that combining parameters would be more robust and sought to develop a multiparametric echocardiographic score for predicting CRT response.
Global longitudinal strain of left ventricle was added to standard echocardiographic measurements in 334 consecutive patients (224 men; mean, 65±12 years) who underwent baseline echocardiography before CRT and underwent follow-up echocardiograms at 1 year. Regression analysis was performed to create an echocardiographic score for prediction of LV reverse remodeling (defined as ≥15% reduction in the LV end-systolic volume). Cox proportional hazards models were used to identify the association of the score with death, transplantation or LV assist device implantation, and heart failure hospitalization during 57±22 months of follow-up. LV reverse remodeling (n=161; 48%) was associated with pre-CRT LV end-diastolic dimension index <3.1 cm/m(2), global longitudinal strain of left ventricle <-7%, left atrial area <26 cm(2), right ventricular end-diastolic area index <10.0 cm(2)/m(2), right atrial area <20 cm(2), and right ventricular fractional area change ≥35%. Combination of these into an echocardiographic score allowed prediction of LV reverse remodeling with a sensitivity of 84% and a specificity of 79%. During follow-up, there were 134 deaths, 18 heart transplantations/LV assist device implantations, and 93 heart failure admissions. The score was associated with heart failure admission, heart transplantation/LV assist device, or death (hazard ratio, 0.97; 95% confidence interval, 0.95-0.98; P<0.001) and all-cause death (hazard ratio, 0.97; 95% confidence interval, 0.96-0.98; P<0.001), independent of age, sex, ischemic cause, and initial functional class.
A multiparametric echocardiographic score is helpful in selecting patients likely to undergo reverse remodeling after CRT and predicts clinical outcomes.
心脏再同步治疗（CRT）后反应的超声心动图预测因素的研究大多涉及单一参数。我们假设联合参数会更稳健，并试图开发一种多参数超声心动图评分来预测 CRT 反应。
在 334 例连续患者（224 例男性；平均年龄 65±12 岁）中，左心室整体纵向应变被添加到标准超声心动图测量中，这些患者在 CRT 前接受了基线超声心动图检查，并在 1 年后接受了随访超声心动图检查。进行回归分析以创建预测左心室逆重构的超声心动图评分（定义为左心室收缩末期容积减少≥15%）。Cox 比例风险模型用于确定评分与 57±22 个月随访期间死亡、移植或左心室辅助装置植入以及心力衰竭住院之间的关联。左心室逆重构（n=161；48%）与 CRT 前左心室舒张末期内径指数<3.1 cm/m2、左心室整体纵向应变<-7%、左心房面积<26 cm2、右心室舒张末期面积指数<10.0 cm2/m2、右心房面积<20 cm2 和右心室分数面积变化≥35%相关。将这些组合成一个超声心动图评分，可以以 84%的敏感性和 79%的特异性预测左心室逆重构。在随访期间，有 134 例死亡、18 例心脏移植/LV 辅助装置植入和 93 例心力衰竭入院。该评分与心力衰竭入院、心脏移植/LV 辅助装置或死亡（危险比，0.97；95%置信区间，0.95-0.98；P<0.001）和全因死亡（危险比，0.97；95%置信区间，0.96-0.98；P<0.001）相关，与年龄、性别、缺血性病因和初始功能分级无关。
多参数超声心动图评分有助于选择 CRT 后可能发生逆重构的患者，并预测临床结局。
