心脏再同步治疗中心脏磁共振成像确定的左心室射血分数的区域性贡献。
Regional contributions to left ventricular stroke volume determined by cardiac magnetic resonance imaging in cardiac resynchronization therapy.
机构信息
Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Section for Heart Failure and Valvular Disease, Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
出版信息
BMC Cardiovasc Disord. 2021 Oct 26;21(1):519. doi: 10.1186/s12872-021-02325-7.
BACKGROUND
Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SV), lateral (SV), and septal (SV) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response.
METHODS
Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms) underwent CMR. SV was calculated as the volume encompassed by the atrioventricular plane displacement (AVPD) from end diastole (ED) to end systole (ES) divided by total SV. SV, and SV were calculated as the volume encompassed by radial contraction from ED to ES. Twenty age- and sex-matched healthy volunteers were used as controls. The regional measures were compared to outcome response defined as ≥ 15% decrease in echocardiographic LV end-systolic volume (LVESV) from pre- to 6-months post CRT (delta, Δ).
RESULTS
AVPD and SV were lower in patients compared to controls (8.3 ± 3.2 mm vs 15.3 ± 1.6 mm, P < 0.001; and 53 ± 18% vs 64 ± 8%, P < 0.01). SV was lower (0 ± 15% vs 10 ± 4%, P < 0.01) with a higher SV in the patient group (42 ± 16% vs 29 ± 7%, P < 0.01). There were no differences between responders and non-responders in neither SV (P = 0.87), SV (P = 0.09), nor SV (P = 0.65). In patients with septal net motion towards the right ventricle (n = 28) ΔLVESV was - 18 ± 22% and with septal net motion towards the LV (n = 37) ΔLVESV was - 19 ± 23% (P = 0.96).
CONCLUSIONS
Longitudinal function, expressed as AVPD and longitudinal contribution to SV, is decreased in patients with HF scheduled for CRT. A larger lateral contribution to SV compensates for the abnormal septal systolic net movement. However, LV reverse remodeling could not be predicted by these regional contributors to SV.
背景
心脏再同步治疗（CRT）可恢复心力衰竭（HF）和不同步患者的心室同步性，并诱导左心室（LV）逆向重构。然而，尽管已经进行了所有努力，仍有 30%的治疗患者没有反应。心脏磁共振成像（CMR）可用于量化区域对每搏输出量（SV）的贡献，作为潜在的 CRT 预测指标。本研究旨在确定 LV 纵向（SV）、横向（SV）和间隔（SV）对 SV 的贡献是否与健康对照组不同，并探讨这些参数是否可以预测 CRT 反应。
方法
65 名有症状的 HF 患者（19 名女性，67±9 岁，LVEF≤35%）和宽 QRS（≥120 ms）接受 CMR 检查。SV 计算为房室平面位移（AVPD）从舒张末期（ED）到收缩末期（ES）的体积除以总 SV。SV 和 SV 计算为从 ED 到 ES 的径向收缩所包含的体积。20 名年龄和性别匹配的健康志愿者作为对照组。将区域测量值与定义为 CRT 后 6 个月超声心动图 LV 收缩末期容积（LVESV）降低≥15%的结果反应（Δ，Δ）进行比较。
结果
与对照组相比，患者的 AVPD 和 SV 较低（8.3±3.2mm 与 15.3±1.6mm，P<0.001；53±18%与 64±8%，P<0.01）。SV 较低（0±15%与 10±4%，P<0.01），患者组 SV 较高（42±16%与 29±7%，P<0.01）。在反应者和无反应者中，SV（P=0.87）、SV（P=0.09）和 SV（P=0.65）均无差异。在间隔向右侧心室的净运动（n=28）的患者中，ΔLVESV 为-18±22%，而间隔向左侧心室的净运动（n=37）的ΔLVESV 为-19±23%（P=0.96）。
结论
HF 患者拟行 CRT 时，纵向功能（以 AVPD 和 SV 的纵向贡献表示）降低。SV 的较大侧向贡献补偿了异常的间隔收缩净运动。然而，这些 SV 的区域贡献并不能预测 LV 逆向重构。
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