Poulidakis Emmanouil, Aggeli Constantina, Sideris Skevos, Sfendouraki Eliza, Koutagiar Iosif, Katsaros Andreas, Giannoulis Evangelos, Koukos Markos, Margioula Eleni, Lagoudakou Stavroula, Gatzoulis Kostas, Dilaveris Polychronis, Kallikazaros Ioannis, Couloheri Stavroula, Stefanadis Christodoulos, Tousoulis Dimitrios
Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece.
Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
Int J Cardiovasc Imaging. 2019 Feb;35(2):285-294. doi: 10.1007/s10554-018-01520-6. Epub 2019 Jan 8.
Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.
尽管选择标准有所完善，但心脏再同步治疗（CRT）无反应仍然是一个问题。本研究的目的是探讨负荷超声心动图联合不同步参数在识别CRT反应者或延迟反应者中的作用。106例有症状的心力衰竭患者在CRT实施前、实施后6个月以及2至4年进行了检查。通过负荷超声心动图研究心肌收缩储备（ICR）和下外侧（IL）壁存活情况。通过以下方法评估不同步性：（1）M型测量室间隔与后壁运动延迟（SPWMD）。（2）组织多普勒成像测量室间隔与侧壁延迟（SLD）。（3）脉冲波多普勒测量心室间机械延迟（IVMD）。（4）斑点追踪测量圆周应变达峰时间差异（TmaxCS）。（5）视觉评估心尖摆动（ApR）和室间隔闪烁（SF）。6个月时，有54例反应者，另有12例延迟反应者。TmaxCS的预测价值最大，曲线下面积（AUC）为0.835，其次是ICR和IL壁存活两者均存在（AUC 0.799）、M型（AUC = 0.775）以及ApR或SF存在（AUC = 0.772）。如果将延迟反应者也包括在内，ApR和ICR的预测能力会增强。在ICR和IL壁均存活的患者中，不同步参数的性能会增强。负荷超声心动图和不同步参数是6个月及延迟CRT反应的简单可靠预测指标。一种逐步的方法，首先评估ICR和存活情况，如果结果为阳性，则进一步进行不同步分析，有助于决策制定。
