Biering-Sørensen Tor, Olsen Flemming Javier, Storm Katrine, Fritz-Hansen Thomas, Olsen Niels Thue, Jøns Christian, Vinther Michael, Søgaard Peter, Risum Niels
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
Eur Heart J Cardiovasc Imaging. 2016 Jul;17(7):722-31. doi: 10.1093/ehjci/jew066. Epub 2016 Apr 15.
Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention receive appropriately therapy. We sought to investigate the value of tissue Doppler imaging (TDI) to predict ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiovascular mortality (CVD) in patients with primary prevention ICD.
In total, 151 ICD patients meeting primary prevention criteria and with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates. Forty patients experienced the combined endpoint of VT, VF, or CVD during a median follow-up of 2.3 years. Left ventricular ejection fraction, global longitudinal strain, E/e', global s', and global e' were not significantly different in patients who developed VT/VF/CVD compared with those who did not. In contrast, global a' was significantly lower in patients with an unfavourable outcome compared with those without (4.8 ± 2.0 vs. 5.7 ± 1.8 cm/s, P = 0.020). Global a' remained an independent predictor of VT/VF/CVD after multivariable adjustment for age, gender, β-blocker therapy, and deceleration time (HR = 1.25 [1.02, 1.54], P = 0.032). Regional analysis revealed that a depressed a' in the inferior wall drives the predictive capability of a'.
Late diastolic velocity by TDI seems to be a superior echocardiographic predictor of VT/VF/CVD in ischaemic cardiomyopathy. Additionally, impaired late diastolic velocity in the inferior myocardial wall seems to be a paramount marker of future VT/VF/CVD.
接受植入式心脏复律除颤器（ICD）进行一级预防的患者中，只有30%接受了适当的治疗。我们试图研究组织多普勒成像（TDI）在预测一级预防ICD患者室性心动过速（VT）、心室颤动（VF）和心血管死亡率（CVD）方面的价值。
总共纳入了151例符合一级预防标准且无室性心律失常病史的ICD患者。所有参与者均接受了常规二维超声心动图和TDI超声心动图检查。使用TDI在六个二尖瓣环部位测量纵向收缩期（s'）、舒张早期（e'）和舒张晚期（a'）心肌速度，并进行平均以提供整体估计值。在中位随访2.3年期间，40例患者经历了VT、VF或CVD的联合终点。发生VT/VF/CVD的患者与未发生者相比，左心室射血分数、整体纵向应变、E/e'、整体s'和整体e'无显著差异。相比之下，预后不良的患者的整体a'显著低于未发生不良事件者（4.8±2.0 vs. 5.7±1.8 cm/s, P = 0.020）。在对年龄、性别、β受体阻滞剂治疗和减速时间进行多变量调整后，整体a'仍然是VT/VF/CVD的独立预测因素（HR = 1.25 [1.02, 1.54], P = 0.032）。区域分析显示，下壁a'降低驱动了a'的预测能力。
TDI舒张晚期速度似乎是缺血性心肌病中VT/VF/CVD的一种优越超声心动图预测指标。此外，下心肌壁舒张晚期速度受损似乎是未来VT/VF/CVD的一个至关重要的标志物。
