den Boer Susanna L, du Marchie Sarvaas Gideon J, Klitsie Liselotte M, van Iperen Gabriëlle G, Tanke Ronald B, Helbing Willem A, Backx Ad P C M, Rammeloo Lukas A J, Dalinghaus Michiel, Ten Harkel Arend D J
Departments of Pediatrics, Division of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands.
Departments of Pediatrics, Division of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Echocardiography. 2017 Jun;34(6):881-887. doi: 10.1111/echo.13548. Epub 2017 May 7.
This study aimed to evaluate the predicting value of quantitative and qualitative dyssynchrony parameters as assessed by two-dimensional speckle tracking echocardiography (STE) on outcome in children with dilated cardiomyopathy (DCM). Furthermore, the reproducibility of these parameters was investigated.
In previous studies in adults with heart failure, several dyssynchrony parameters have been shown to be a valuable predictor of clinical outcome.
This multicenter, prospective study included 75 children with DCM and 75 healthy age-matched controls. Using STE, quantitative (time to global peak strain and parameters describing intraventricular time differences) and qualitative dyssynchrony parameters (pattern analysis) of the apical four-chamber, three-chamber, two-chamber views, and the short axis of the left ventricle were assessed. Cox regression was used to identify risk factors for the primary endpoints of death or heart transplantation. Inter-observer and intra-observer variability were described.
During a median of 21 months follow-up, 10 patients (13%) reached an endpoint. Although quantitative dyssynchrony measures were higher in patients as compared to controls, the inter-observer and intra-observer variability were high. Pattern analysis showed mainly reduced strain, instead of dyssynchronous patterns.
In this study, quantitative dyssynchrony parameters were not reproducible, precluding their use in children. Qualitative pattern analysis showed predominantly reduced strain, suggesting that in children with DCM dyssynchrony may be a minor problem.
本研究旨在评估二维斑点追踪超声心动图（STE）所评估的定量和定性不同步参数对扩张型心肌病（DCM）患儿预后的预测价值。此外，还研究了这些参数的可重复性。
在先前针对成年心力衰竭患者的研究中，已证明几种不同步参数是临床预后的重要预测指标。
这项多中心前瞻性研究纳入了75例DCM患儿和75例年龄匹配的健康对照者。使用STE评估心尖四腔心、三腔心、两腔心视图以及左心室短轴的定量（整体峰值应变时间和描述心室内时间差异的参数）和定性不同步参数（模式分析）。采用Cox回归确定死亡或心脏移植等主要终点的危险因素。描述了观察者间和观察者内的变异性。
在中位随访21个月期间，10例患者（13%）达到终点。尽管与对照组相比，患者的定量不同步测量值更高，但观察者间和观察者内的变异性都很高。模式分析主要显示应变降低，而非不同步模式。
在本研究中，定量不同步参数不可重复，因此无法用于儿童。定性模式分析主要显示应变降低，这表明在DCM患儿中，不同步可能是一个较小的问题。
