源自左心室压力-应变环的无创心肌工作指数在预测心脏再同步治疗反应中的价值。
The value of non-invasive myocardial work indices derived from left ventricular pressure-strain loops in predicting the response to cardiac resynchronization therapy.
作者信息
Zhu Mengruo, Wang Yanan, Cheng Yufei, Su Yangang, Chen Haiyan, Shu Xianhong
机构信息
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
Quant Imaging Med Surg. 2021 Apr;11(4):1406-1420. doi: 10.21037/qims-20-754.
BACKGROUND
Non-invasive left ventricular (LV) pressure-strain loops (PSLs), which are generated by combining LV longitudinal strain with brachial artery blood pressure, provide a novel method of quantifying global and segmental myocardial work (MW) indices with potential advantages over conventional echocardiographic strain data, which suffers from being load-dependent. This method has been recently introduced in echocardiographic software, enhancing the efficiency of MW calculations. This study aimed to evaluate the role of non-invasive MW indices derived from LV PSLs in predicting cardiac resynchronization therapy (CRT) response.
METHODS
A total of 106 heart failure (HF) patients scheduled for CRT were included in the MW analysis. Global and segmental (septal and lateral at the mid-ventricular level) MW indices were assessed before CRT and at a 6-month follow-up. Response to CRT was defined as ≥15% reduction in LV end-systolic volume and ≥1 NYHA functional class improvement at 6-month follow-up compared to baseline.
RESULTS
CRT response was observed in 78 (74%) patients. At baseline, the global work index (GWI) and global constructive work (GCW) were significantly higher in CRT responders than in non-responders (both P<0.05). Furthermore, responders exhibited significantly higher mid lateral MW and mid lateral constructive work (CW) (both P<0.001), but significantly lower mid septal MWI and mid septal myocardial work efficiency (MWE) than non-responders (all P<0.01). Baseline mid septal MWE (OR 0.975, 95% CI: 0.959-0.990, P=0.002) and mid lateral MWI (OR 1.003, 95% CI: 1.002-1.004, P<0.001) were identified as independent predictors of CRT response in multivariate regression analysis. Mid septal MWE ≤42% combined with mid lateral MWI ≥740 mmHg% predicted CRT response, with an optimal sensitivity of 79% and specificity of 82% [area under the receiver operating characteristic curve (AUC) =0.830, P<0.001].
CONCLUSIONS
Assessment of MW indices before CRT could identify the marked imbalance in LV MW distribution and can be widely used as a reliable complementary tool for guiding patient selection for CRT in clinical practice.
背景
无创左心室（LV）压力-应变环（PSL）通过将左心室纵向应变与肱动脉血压相结合生成，提供了一种量化整体和节段性心肌作功（MW）指标的新方法，与传统超声心动图应变数据相比具有潜在优势，传统应变数据受负荷依赖性影响。该方法最近已被引入超声心动图软件中，提高了心肌作功计算的效率。本研究旨在评估从左心室PSL得出的无创心肌作功指标在预测心脏再同步治疗（CRT）反应中的作用。
方法
共有106例计划接受CRT的心力衰竭（HF）患者纳入心肌作功分析。在CRT前及随访6个月时评估整体和节段性（心室中部水平的室间隔和侧壁）心肌作功指标。CRT反应定义为与基线相比，随访6个月时左心室收缩末期容积减少≥15%且纽约心脏协会（NYHA）功能分级改善≥1级。
结果
78例（74%）患者观察到CRT反应。基线时，CRT反应者的整体作功指数（GWI）和整体建设性作功（GCW）显著高于无反应者（均P<0.05）。此外，反应者的侧壁中部心肌作功和侧壁中部建设性作功（CW）显著更高（均P<0.001），但室间隔中部心肌作功指数（MWI）和室间隔中部心肌作功效率（MWE）显著低于无反应者（均P<0.01）。多因素回归分析中，基线室间隔中部MWE（比值比0.975，95%置信区间：0.959-0.990，P=0.002）和侧壁中部MWI（比值比1.003，95%置信区间：1.002-1.004，P<0.001）被确定为CRT反应的独立预测因素。室间隔中部MWE≤42%联合侧壁中部MWI≥740 mmHg%预测CRT反应，最佳敏感性为79%，特异性为82%[受试者工作特征曲线下面积（AUC）=0.830，P<0.001]。
结论
CRT前评估心肌作功指标可识别左心室心肌作功分布的明显失衡，可作为临床实践中指导CRT患者选择的可靠补充工具广泛应用。
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