Maruo Takeshi, Seo Yoshihiro, Yamada Satoshi, Arita Takeshi, Ishizu Tomoko, Shiga Tsuyoshi, Dohi Kaoru, Toide Hiroyuki, Furugen Azusa, Inoue Katsuji, Daimon Masao, Kawai Hiroya, Tsuruta Hikaru, Nishigami Kazuhiro, Yuda Satoshi, Ozawa Tomoya, Izumi Chisato, Fumikura Yuko, Wada Yasuaki, Doi Mariko, Okada Masafumi, Takenaka Katsu, Aonuma Kazutaka
Department of Cardiology, Kurashiki Central Hospital.
Circ J. 2015;79(3):613-22. doi: 10.1253/circj.CJ-14-0842. Epub 2014 Dec 27.
We sought to identify the feasibility of speckle tracking echocardiography (STE) to predict cardiac resynchronization therapy (CRT) responders in a prospective multicenter study. METHODS AND RESULTS: Patients who were newly implanted with a CRT device were enrolled. Time (T) from QRS to maximum peak radial and circumferential strain (CS) in 6 segments on the left ventricular (LV) short-axis plane, and to the maximum peak of longitudinal strain in 18 segments on 3 apical LV planes was measured (Tmax). In segments with multiple peaks on the time-strain curves, time to the first peak (Tfirst) was also assessed. Difference in T between the earliest and latest segment and standard deviation (SD) of T in each strain component were assessed. CRT responders were defined as having LV end-systolic volume reduction >15% at 6 months after CRT. Clinical outcomes were assessed with a composite endpoint of death from cardiac causes or unplanned hospitalization for heart failure. Among 180 patients, 109 patients were identified as responders. Tfirst-SD of CS >116 ms was selected as the best independent predictor of CRT responders (P<0.001, hazard ratio=9.83, 95% confidence interval 3.78-25.6). In addition, Tfirst-SD of CS was associated with the clinical endpoints.
This prospective multicenter study revealed the high feasibility of dyssynchrony assessment by STE, which may improve the ability to predict CRT responders.
我们试图在一项前瞻性多中心研究中确定斑点追踪超声心动图（STE）预测心脏再同步治疗（CRT）反应者的可行性。方法与结果：纳入新植入CRT设备的患者。测量从QRS波起始至左心室（LV）短轴平面6个节段的最大径向和圆周应变（CS）峰值的时间（T），以及至LV 3个心尖平面18个节段的纵向应变最大峰值的时间（Tmax）。对于时间-应变曲线上有多个峰值的节段，还评估至第一个峰值的时间（Tfirst）。评估最早和最晚节段之间的T差异以及每个应变分量中T的标准差（SD）。CRT反应者定义为CRT治疗后6个月时LV收缩末期容积减少>15%。临床结局通过心脏原因死亡或因心力衰竭计划外住院的复合终点进行评估。在180例患者中，109例患者被确定为反应者。CS的Tfirst-SD>116 ms被选为CRT反应者的最佳独立预测指标（P<0.001，风险比=9.83，95%置信区间3.78-25.6）。此外，CS的Tfirst-SD与临床终点相关。
这项前瞻性多中心研究揭示了STE评估不同步性的高度可行性，这可能提高预测CRT反应者的能力。
