Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Cardiology, University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Eur Heart J Cardiovasc Imaging. 2024 Nov 27;25(12):1721-1733. doi: 10.1093/ehjci/jeae181.
Cardiac resynchronization therapy (CRT) may induce left ventricular (LV) reverse remodelling (=LV response) in patients with heart failure. Intraventricular pressure gradients can be quantified using echocardiography-derived haemodynamic forces (HDF). The aim was to evaluate the association between baseline HDF and LV response and to compare the change of HDF after CRT between LV responders and LV non-responders.
The following HDF parameters were assessed: (i) apical-basal (AB) strength, (ii) lateral-septal strength, (iii) force vector angle, (iv) systolic AB impulse, (v) systolic force vector angle. LV response was defined as a reduction of LV end-systolic volume ≥ 15% at six months. One hundred ninety-six patients were included [64 ± 11 years, 122 (62%) men], 136 (69%) showed LV response. On multivariable logistic regression analysis, the force vector angle in the complete heart cycle [OR 1.083 (95% CI: 1.018, 1.153), P = 0.012] and the systolic force vector angle [OR 1.089 (95% CI: 1.021, 1.161), P = 0.009], both included in separate models, were independently associated with LV response. Six months after CRT, LV responders had greater AB strength, AB impulse, and higher force vector angles, while LV non-responders only showed improvement in the force vector angle in the complete heart cycle.
The orientation of HDF at baseline is associated with LV response to CRT. Six months after CRT, the orientation of HDF improves in LV responders and LV non-responders, while the magnitude of AB HDF only improves in LV responders.
心脏再同步治疗（CRT）可使心力衰竭患者的左心室（LV）发生逆向重构（=LV 反应）。可以使用超声心动图衍生的血流动力学力（HDF）来量化心室内压力梯度。目的是评估基线 HDF 与 LV 反应之间的相关性，并比较 LV 反应者和 LV 无反应者 CRT 后 HDF 的变化。
评估了以下 HDF 参数：（i）心尖基底（AB）强度，（ii）侧壁间隔强度，（iii）力矢量角度，（iv）收缩期 AB 冲量，（v）收缩期力矢量角度。LV 反应定义为 6 个月时 LV 收缩末期容积减少≥15%。共纳入 196 例患者[64±11 岁，122（62%）男性]，136 例（69%）出现 LV 反应。多变量逻辑回归分析显示，完整心动周期中的力矢量角度[OR 1.083（95%CI：1.018，1.153），P=0.012]和收缩期力矢量角度[OR 1.089（95%CI：1.021，1.161），P=0.009]，这两个参数都包含在单独的模型中，与 LV 反应独立相关。CRT 后 6 个月，LV 反应者的 AB 强度、AB 冲量更高，力矢量角度更大，而 LV 无反应者仅在完整心动周期中的力矢量角度方面有所改善。
基线 HDF 的方向与 CRT 对 LV 的反应相关。CRT 后 6 个月，LV 反应者和 LV 无反应者的 HDF 方向均得到改善，而 LV 反应者的 AB HDF 幅度仅得到改善。
