二维斑点追踪技术测量的室间隔应变与左心室功能不全合并左束支传导阻滞患者心脏再同步治疗反应之间的关系：一项前瞻性初步研究。

Relationship between two-dimensional speckle-tracking septal strain and response to cardiac resynchronization therapy in patients with left ventricular dysfunction and left bundle branch block: a prospective pilot study.

作者信息

Maréchaux Sylvestre, Guiot Aurélie, Castel Anne Laure, Guyomar Yves, Semichon Marc, Delelis François, Heuls Sebastien, Ennezat Pierre-Vladimir, Graux Pierre, Tribouilloy Christophe

机构信息

Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France.

出版信息

J Am Soc Echocardiogr. 2014 May;27(5):501-11. doi: 10.1016/j.echo.2014.01.004. Epub 2014 Feb 8.

DOI:10.1016/j.echo.2014.01.004

PMID:24513239

Abstract

BACKGROUND

Previous studies have demonstrated variable patterns of longitudinal septal deformation in patients with left ventricular (LV) dysfunction and left bundle branch block. This prospective single center study was designed to assess the relationship between septal deformation patterns obtained by two-dimensional speckle-tracking echocardiography and response to cardiac resynchronization therapy (CRT).

METHODS

One hundred one patients with New York Heart Association class II to IV heart failure, LV ejection fractions ≤ 35%, and left bundle branch block underwent echocardiography before CRT. Longitudinal two-dimensional speckle-tracking strain analysis in the apical four-chamber view identified three patterns: double-peaked systolic shortening (pattern 1), early pre-ejection shortening peak followed by prominent systolic stretch (pattern 2), and pseudonormal shortening with a late systolic shortening peak and less pronounced end-systolic stretch (pattern 3). CRT response was defined as a relative reduction in LV end-systolic volume of ≥ 15% at 9-month follow-up. CRT super-response was defined as an absolute LV ejection fraction of ≥ 50% associated with a relative reduction in LV end-systolic volume of ≥ 15% and an improvement in New York Heart Association functional class. Cardiac death or hospitalization for heart failure during follow-up was systematically investigated.

RESULTS

Ninety-two percent of patients with pattern 1 or 2 were responders to CRT compared with 59% with pattern 3 (P < .0001). Thirty-six percent of patients with pattern 1 were super-responders compared with 15% of those with pattern 2 and 12% of those with pattern 3 (P = .037). The improvement in LV volumes, LV ejection fraction, and global longitudinal strain after CRT was better in patients with pattern 1 or 2 compared with those with pattern 3 (P < .0001 for all). Eighteen-month outcomes were excellent in patients with pattern 1 or 2, with event-free survival of 95 ± 3% compared with 75 ± 7% in patients with pattern 3 (P = .010).

CONCLUSIONS

Septal deformation strain pattern 1 or 2 is highly predictive of CRT response. Further studies are needed to identify predictors of "nonresponse" in patients with a pattern 3.

摘要

背景

既往研究已证实，左心室（LV）功能障碍和左束支传导阻滞患者的室间隔纵向变形模式存在差异。本前瞻性单中心研究旨在评估二维斑点追踪超声心动图获得的室间隔变形模式与心脏再同步治疗（CRT）反应之间的关系。

方法

101例纽约心脏病协会（NYHA）心功能II至IV级、左心室射血分数≤35%且存在左束支传导阻滞的患者在CRT治疗前接受了超声心动图检查。在心尖四腔视图中进行纵向二维斑点追踪应变分析，确定了三种模式：双峰收缩期缩短（模式1）、射血前期早期缩短峰值后跟随明显的收缩期拉伸（模式2）以及假性正常缩短，伴有收缩期末期缩短峰值且收缩期末期拉伸不明显（模式3）。CRT反应定义为在9个月随访时左心室收缩末期容积相对减少≥15%。CRT超反应定义为绝对左心室射血分数≥50%，同时左心室收缩末期容积相对减少≥15%且纽约心脏病协会功能分级改善。对随访期间的心源性死亡或因心力衰竭住院情况进行了系统调查。

结果

模式1或2的患者中92%对CRT有反应，而模式3的患者中这一比例为59%（P <.0001）。模式1的患者中有36%为超反应者，模式2的患者中这一比例为15%，模式3的患者中为12%（P =.037）。与模式3的患者相比，模式1或2的患者在CRT治疗后左心室容积、左心室射血分数和整体纵向应变的改善情况更好（所有P <.0001）。模式1或2的患者18个月的预后良好，无事件生存率为95±3%，而模式3的患者为75±7%（P =.010）。