Gurgu Andra, Luca Constantin-Tudor, Vacarescu Cristina, Petrescu Lucian, Goanta Emilia-Violeta, Lazar Mihai-Andrei, Arnăutu Diana-Aurora, Cozma Dragos
Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania.
Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania.
Diagnostics (Basel). 2023 Mar 21;13(6):1186. doi: 10.3390/diagnostics13061186.
CRT improves systolic and diastolic function, increasing cardiac output. Aim of the study: to assess the outcome of LV diastolic dyssynchrony in a population of fusion pacing CRT. Diastolic dyssynchrony was measured by offline speckle-tracking-derived TDI timing assessment of the simultaneity of E″ and A″ basal septal and lateral walls. New parameters introduced: E″ and, respectively, A″ time (E″T/A″T) as the time difference between E″ (respectively, A″) peak septal and lateral wall. Patients were divided into super-responders (SR), responders (R), and non-responders (NR). Baseline characteristics: 62 pts (62 ± 11 y.o.) with idiopathic DCM, EF 27 ± 5.2%; 29% type III diastolic dysfunction (DD), 63% type II, 8% type I. Average follow-up 45 ± 19 months: LVEF 37 ± 7.9%, 34%SR, 61%R, 5%NR. The E″T decreased from 90 ± 20 ms to 25 ± 10 ms in SR with significant LV reverse remodeling (LV end-diastolic volume 193.7 ± 81 vs. 243.2 ± 82 mL at baseline, < 0.0028) and lower LV filling pressures (E/E' 13.2 ± 4.6 vs. 11.4 ± 4.5, = 0.0295). DD profile improved in 65% of R with a reduction in E/E' ratio (21 ± 9 vs. 14 ± 4 ms, < 0.0001). Significant cut-off value calculated by ROC curve for LV diastolic dyssynchrony is E″T > 80 ms and A″T > 30 msec. The study identifies the cut-off values of diastolic dyssynchrony parameters as predictors of favorable outcomes in responders and super-responder patients with fusion CRT pacing. These findings may have important implications in patient selection and follow-up.
心脏再同步治疗（CRT）可改善心脏的收缩和舒张功能，增加心输出量。本研究目的：评估融合起搏CRT人群中左心室舒张不同步的结果。舒张不同步通过离线斑点追踪衍生的组织多普勒成像（TDI）对室间隔和侧壁基底段E″和A″同步性的定时评估来测量。引入新参数：E″时间（E″T）和A″时间（A″T），分别为室间隔和侧壁E″（分别为A″）峰值之间的时间差。患者分为超反应者（SR）、反应者（R）和无反应者（NR）。基线特征：62例特发性扩张型心肌病患者（年龄62±11岁），射血分数（EF）为27±5.2%；29%为III型舒张功能障碍（DD），63%为II型，8%为I型。平均随访45±19个月：左心室射血分数（LVEF）为37±7.9%，34%为SR，61%为R，5%为NR。在有显著左心室逆向重构的SR患者中，E″T从90±20毫秒降至25±10毫秒（左心室舒张末期容积基线时为193.7±81 vs. 243.2±82毫升，<0.0028），左心室充盈压降低（E/E'为13.2±4.6 vs. 11.4±4.5，=0.0295）。65%的R患者DD情况改善，E/E'比值降低（21±9 vs. 14±4毫秒，<0.0001）。通过ROC曲线计算出的左心室舒张不同步的显著临界值为E″T>80毫秒和A″T>30毫秒。该研究确定了舒张不同步参数的临界值，作为融合CRT起搏反应者和超反应者患者良好预后的预测指标。这些发现可能对患者选择和随访具有重要意义。
