Xu Changhao, Chen Kangyu, Yu Fei, Wang Qi, Su Hao, Yang Dongmei, Xu Jian, Yan Ji
Department of Cardiology, Provincial Hospital, Anhui Medical University, Hefei, China.
Echocardiography Laboratory, Provincial Hospital, Anhui Medical University, Hefei, China.
Cardiology. 2019;144(1-2):18-26. doi: 10.1159/000502541. Epub 2019 Sep 2.
Heart failure may induce atrial dyssynchrony. We aim to investigate whether preimplantation left atrial (LA) dyssynchrony could predict newly detected atrial high-rate episodes (AHRE) after receiving cardiac resynchronization therapy defibrillator (CRT-D).
We conducted a retrospective analysis of consecutive patients who received CRT-D for standard indications and without a history of atrial fibrillation. The standard deviation of the time-to-peak strain in each LA segment during ventricular systole (SDs) and late diastole (SDa) were calculated to quantify LA dyssynchrony using two-dimensional speckle tracking echocardiography before device implantation. Patients were divided into the AHRE group and the AHRE-free group, depending on the presence of AHRE during device interrogation.
Thirty-one patients (28%) had newly detected AHRE during a mean follow-up of 21 ± 9 months. Patients in the AHRE group had higher SDs (8.2 ± 2.6% vs. 6.3 ± 2.3%, p < 0.001) and SDa (5.4 ± 1.8% vs. 4.1 ± 1.4%, p < 0.001) values before implantation than patients in the AHRE-free group. In the multivariate logistic analysis, both SDs (OR 1.325, 95% CI: 1.074-1.636, p =0.009) and SDa (OR: 1.499, 95% CI: 1.071-2.098, p= 0.018) were independent predictors of newly detected AHRE. At a cutoff value of 7.4% for SDs and 5.3% for SDa, the Kaplan-Meier survival analysis showed that patients with higher SDs and SDa had significantly increased risks of newly detected AHRE after receiving CRT-D.
Dyssynchronous LA lengthening and contraction could assist in the prediction of newly detected AHRE in patients with CRT-D.
心力衰竭可能诱发心房不同步。我们旨在研究植入心脏再同步治疗除颤器（CRT-D）前左心房（LA）不同步是否可预测新检测到的心房高率发作（AHRE）。
我们对因标准适应证接受CRT-D且无房颤病史的连续患者进行了回顾性分析。在设备植入前，使用二维斑点追踪超声心动图计算心室收缩期（SDs）和舒张晚期（SDa）每个LA节段达到峰值应变的时间标准差，以量化LA不同步。根据设备问询期间是否存在AHRE，将患者分为AHRE组和无AHRE组。
在平均21±9个月的随访期间，31例患者（28%）新检测到AHRE。与无AHRE组患者相比，AHRE组患者植入前的SDs（8.2±2.6%对6.3±2.3%，p<0.001）和SDa（5.4±1.8%对4.1±1.4%，p<0.001）值更高。在多因素逻辑分析中，SDs（OR 1.325，95%CI：1.074-1.636，p=0.009）和SDa（OR：1.499，95%CI：1.071-2.098，p=0.018）均为新检测到的AHRE的独立预测因素。SDs的截断值为7.4%，SDa的截断值为5.3%，Kaplan-Meier生存分析显示，SDs和SDa较高的患者在接受CRT-D后新检测到AHRE的风险显著增加。
LA延长和收缩不同步有助于预测CRT-D患者新检测到的AHRE。
