GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
INSERM U 1088, Université de Picardie, Amiens, France.
Eur Heart J Cardiovasc Imaging. 2017 Dec 1;18(12):1388-1397. doi: 10.1093/ehjci/jew289.
Specific septal motion related to dyssynchrony is strongly linked to reverse remodelling, in patients with systolic heart failure (HF) receiving cardiac resynchronization therapy (CRT). We aimed to investigate the relationship between septal deformation patterns studied by longitudinal speckle tracking and clinical outcome following CRT.
A total of 284 CRT candidates from two centres (HF NYHA classes II-IV, ejection fraction < 35%, QRS ≥ 120 ms) were prospectively included. Longitudinal strain of the septum in the apical four-chamber view determined three patterns of septal contraction. The endpoints were overall mortality, cardiovascular mortality, and hospitalization for HF. Compared with patterns 1 or 2, pattern 3 was associated with an increased risk for both overall and cardiovascular mortality [hazard ratio (HR) = 3.78, 95% confidence interval (CI): 1.85-7.75, P < 0.001 and HR = 3.84, 95% CI: 1.45-10.16, P = 0.007, respectively] and HF hospitalization (HR = 4.41, 95% CI: 2.18-8.90, P < 0.001). Addition of septal patterns to multivariable models, including baseline QRS width and presence of left bundle branch block, improved risk prediction, and discrimination. In patients with intermediate QRS duration (120-150 ms), pattern 3 remained associated with a worse outcome than pattern 1 or 2 (P < 0.05 for all endpoints).
The identification of septal deformation patterns provides important prognostic information in CRT candidates in addition to ordinary clinical, electrocardiographic, and echocardiographic predictors of outcome in HF patients. This parameter may be particularly useful in patients with intermediate QRS duration in whom the benefit of CRT remains uncertain.
在接受心脏再同步治疗（CRT）的收缩性心力衰竭（HF）患者中，与不同步相关的特定间隔运动与逆重构密切相关。我们旨在研究通过纵向斑点追踪研究的间隔变形模式与 CRT 后临床结果之间的关系。
共前瞻性纳入来自两个中心的 284 名 CRT 候选者（HF NYHA 分级 II-IV，射血分数<35%，QRS≥120ms）。心尖四腔视图中隔的纵向应变确定了三种隔收缩模式。终点是总死亡率、心血管死亡率和 HF 住院率。与模式 1 或 2 相比，模式 3与总死亡率和心血管死亡率增加相关[风险比（HR）=3.78，95%置信区间（CI）：1.85-7.75，P<0.001 和 HR=3.84，95%CI：1.45-10.16，P=0.007]和 HF 住院率（HR=4.41，95%CI：2.18-8.90，P<0.001）。将间隔模式添加到包括基线 QRS 宽度和左束支传导阻滞存在的多变量模型中，改善了风险预测和区分能力。在 QRS 持续时间中等（120-150ms）的患者中，模式 3与模式 1 或 2 相比，预后仍然较差（所有终点 P<0.05）。
除 HF 患者的普通临床、心电图和超声心动图预后预测因素外，间隔变形模式的识别还为 CRT 候选者提供了重要的预后信息。在 QRS 持续时间中等的患者中，该参数可能特别有用，因为 CRT 的获益仍然不确定。
