Beela Ahmed S, Manetti Claudia A, Lyon Aurore, Prinzen Frits W, Delhaas Tammo, Herbots Lieven, Lumens Joost
Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands.
Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.
J Clin Med. 2023 Jul 26;12(15):4908. doi: 10.3390/jcm12154908.
We investigated the impact of baseline left atrial (LA) strain data and estimated left atrial pressure (LAP) by applying the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines on cardiac resynchronization therapy (CRT) outcomes.
Datasets of 219 CRT patients were retrospectively analysed. All patients had full echocardiographic diastolic function assessment before CRT and were classified based on the guideline algorithm into normal LAP (nLAP = 40%), elevated LAP (eLAP = 49%) and indeterminate LAP (iLAP = 11%). All relevant baseline characteristics were analysed. CRT-induced left ventricular (LV) reverse remodeling was measured as the relative change of LV end-systolic volume (LVESV) at 12 ± 6 months after CRT compared to baseline. Patients were followed up for all-cause mortality for a mean of 4.8 years [interquartile range (IQR): 2.7-6.0 years].
At follow-up, CRT resulted in more pronounced reduction of LVESV in patients with nLAP than in patients with eLAP. In univariate analysis, nLAP was associated with LV reverse remodelling ( < 0.001), as well as long-term survival after CRT ( < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent ( < 0.01). Adding LA strain analysis to the guideline algorithm improved the feasibility of LAP estimation without affecting the association between estimated LAP and CRT outcome.
Normal LAP before CRT, estimated using the 2016 ASE/EACVI guideline algorithm, is associated with LV reverse remodelling and long-term survival after CRT. Albeit non-independent, it can serve as a non-invasive imaging-based predictor of effective therapy. Furthermore, the inclusion of LA reservoir strain in the guideline algorithm can enhance the feasibility of LAP estimation without affecting the association between LAP and CRT outcome.
我们通过应用2016年美国超声心动图学会和欧洲心血管影像学会（ASE/EACVI）关于心脏再同步治疗（CRT）结果的指南，研究了基线左心房（LA）应变数据和估计左心房压力（LAP）的影响。
对219例CRT患者的数据集进行回顾性分析。所有患者在CRT前均进行了完整的超声心动图舒张功能评估，并根据指南算法分为正常LAP（nLAP = 40%）、升高LAP（eLAP = 49%）和不确定LAP（iLAP = 11%）。分析了所有相关的基线特征。CRT诱导的左心室（LV）逆向重构通过比较CRT后12±6个月与基线时LV收缩末期容积（LVESV）的相对变化来衡量。对患者进行全因死亡率随访，平均随访4.8年[四分位间距（IQR）：2.7 - 6.0年]。
随访时，与eLAP患者相比，nLAP患者的CRT导致LVESV更显著降低。在单变量分析中，nLAP与LV逆向重构相关（<0.001），也与CRT后的长期生存相关（<0.01）。然而，多变量分析表明，只有CRT后nLAP与LV逆向重构之间的关联是独立的（<0.01）。将LA应变分析添加到指南算法中可提高LAP估计的可行性，而不影响估计LAP与CRT结果之间的关联。
使用2016年ASE/EACVI指南算法估计的CRT前正常LAP与CRT后的LV逆向重构和长期生存相关。尽管不独立，但它可作为基于非侵入性成像的有效治疗预测指标。此外，在指南算法中纳入LA储备应变可提高LAP估计的可行性，而不影响LAP与CRT结果之间的关联。
