Satish Priyanka, Narasimhan Bharat, Hagendorff Andreas, Tayal Bhupendar
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
Leipzig University Hospital, Department of Cardiology, Leipzig, Germany.
J Geriatr Cardiol. 2022 Jan 28;19(1):44-51. doi: 10.11909/j.issn.1671-5411.2022.01.010.
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
随着心脏再同步治疗（CRT）试验结果的公布，机电不同步在心力衰竭中的作用在文献中受到了广泛关注。CRT已被证明可显著降低存在不同步的心力衰竭患者的住院率和死亡率。目前的指南建议，根据体表心电图上QRS波时限>150毫秒且呈左束支传导阻滞图形来判断电不同步，以识别可能从CRT植入中获益的患者。然而，预测CRT的反应仍然是一项挑战，近三分之一的患者无法从该装置中获益。在过去二十年中，人们对多种机械不同步的超声心动图测量方法进行了研究。然而，将机械不同步作为CRT的附加或唯一标准的试验未能显示出对CRT反应有任何益处。这表明，在评估不同步时应更深入地理解心脏力学。本综述讨论了成像技术在评估心脏不同步中的不断演变的作用及其在考虑接受器械治疗的患者中的应用。
