平衡放射性核素血管造影术与组织多普勒成像术在检测右心室不同步及预测心脏再同步治疗急性反应方面的比较
Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy.
作者信息
Chen Yu, Xue Xue, Gu Yang, Xu Haiyan, Zhang Xiwen
机构信息
Department of Cardiology.
Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, Jiangsu, China.
出版信息
Medicine (Baltimore). 2020 Feb;99(9):e19296. doi: 10.1097/MD.0000000000019296.
OBJECTIVE
The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT).
METHODS
This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed.
RESULTS
Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ± 4.15% to 43.95 ± 6.88% and 14.00 ± 2.41% to 10.40 ± 1.67%, P < .05), whereas RV-T remained unchanged (50.10 ± 10.28 ms to 49.25 ± 13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity.
CONCLUSION
ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.
目的
本研究旨在比较组织多普勒成像（TDI）和平衡放射性核素血管造影（ERNA）在检测右心室（RV）不同步及预测心脏再同步治疗（CRT）急性反应方面的效果。
方法
本研究经淮安市第一人民医院当地伦理委员会批准。由于本研究使用的是完全匿名的图像，无法识别个体身份，因此未获取患者同意。33例非缺血性扩张型心肌病患者在CRT植入前及植入后48小时内均接受了TDI和ERNA检查。使用TDI通过测量右心室游离壁和室间隔之间收缩期峰值速度时间差（RV-T）来评估RV不同步。通过ERNA评估右心室平均相位角和右心室相位标准差（RVmPA%和RVPSD%）的标准。
结果
在基线RVmPA%、RVPSD%和RV-T之间观察到中度正相关（r = 0.689和0.716，P <.001）。20例（61%）左心室收缩末期容积至少降低15%的患者在CRT后被归类为急性反应者。反应者在CRT后RVmPA%和RVPSD%显著降低（从53.60±4.15%降至43.95±6.88%，从14.00±2.41%降至10.40±1.67%，P <.05），而RV-T保持不变（从50.10±10.28毫秒降至49.25±13.64毫秒，无显著性差异）。受试者工作特征曲线显示，RV-T的截断值为48.5毫秒，预测CRT急性反应的敏感性为65%，特异性为77%。RVmPA%的截断值为49.5%，敏感性为85%，特异性为85%；RVPSD%的截断值为11.5%，敏感性为85%，特异性为92%。
结论
ERNA可能是评估RV不同步的TDI的合适替代方法。RVmPA%或RVPSD%对CRT急性反应具有高度预测性。
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