评估实时三维超声心动图在心脏再同步治疗中的预测效能。
Evaluating the predictive efficacy of real-time 3D echocardiography in cardiac resynchronization therapy.
作者信息
Zhou Zhong-Yin, Zhu Jian-Xiang, Zhao Dong-Sheng, Ding Bing-Qian, Wang Jia-Ling, Lin Gang
机构信息
Department of Echocardiography, Affiliated Hospital 2 of Nantong University, First People's Hospital of Nantong City, Nantong, 226006, China.
Department of Cardiology, Affiliated Hospital 2 of Nantong University, First People's Hospital of Nantong City, No. 666 Shengli Road, Chongchuan District, Nantong, 226006, China.
出版信息
J Cardiothorac Surg. 2024 Oct 1;19(1):580. doi: 10.1186/s13019-024-03058-2.
BACKGROUND
The aim of this study is to assess the predictive efficacy of real-time three-dimensional echocardiography (RT-3DE) and QRS wave duration in determining the response to cardiac resynchronization therapy (CRT) and assessing left ventricular systolic function pre- and post-CRT device implantation.
METHOD
A total of 51 patients with heart failure undergoing CRT at the Second Affiliated Hospital of Nantong University between January 1, 2013, and October 31, 2020, were enrolled in this study. Traditional two-dimensional echocardiography and RT-3DE were performed pre and post-CRT, with QRS wave width data from electrocardiograms and additional clinical information collected. Patients were categorized into CRT responder (n = 36) and CRT non-responder (n = 15) groups based on their response to CRT device implantation. Comparative analyses were conducted on the general characteristics of both groups, as well as the predictive efficacy of RT-3DE and QRS wave width for CRT responsiveness and left ventricular systolic function. Data on the standard deviation (Tmsv16-SD, Tmsv12-SD, Tmsv6-SD) and maximum difference (Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif) of left ventricular end-systolic volume (LVESV) at segments 16, 12, and 6, as well as QRS wave width, were collected and analyzed.
RESULTS
The indicators Tmsv6-Dif, Tmsv12-Dif, Tmsv16-Dif, Tmsv6-SD, Tmsv12-SD, Tmsv16-SD, and QRS wave width exhibited significantly higher values in the CRT responder group when compared to the CRT non-responder group (P < 0.05). Among these, Tmsv16-SD demonstrated superior predictive performance for post-CRT response, with a sensitivity of 88.9%, specificity of 80.0%, and a diagnostic cut-off value of 6.19%. This predictive capability exceeded that of the conventional indicator, QRS wave width.
CONCLUSION
RT-3DE enables accurate prediction of post-CRT patient response and significantly facilitates quantitative assessment of CRT therapy efficacy.
背景
本研究旨在评估实时三维超声心动图（RT-3DE）和QRS波时限在确定心脏再同步治疗（CRT）反应以及评估CRT设备植入前后左心室收缩功能方面的预测效能。
方法
选取2013年1月1日至2020年10月31日在南通大学第二附属医院接受CRT治疗的51例心力衰竭患者纳入本研究。在CRT治疗前后进行传统二维超声心动图和RT-3DE检查，收集心电图的QRS波宽度数据及其他临床信息。根据患者对CRT设备植入的反应，将患者分为CRT反应者（n = 36）和CRT无反应者（n = 15）组。对两组的一般特征以及RT-3DE和QRS波宽度对CRT反应性和左心室收缩功能的预测效能进行比较分析。收集并分析左心室16、12和6节段的收缩末期容积（LVESV）的标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）和最大差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）以及QRS波宽度的数据。
结果
与CRT无反应者组相比，CRT反应者组的Tmsv6-Dif、Tmsv12-Dif、Tmsv16-Dif、Tmsv6-SD、Tmsv12-SD、Tmsv16-SD指标和QRS波宽度值显著更高（P < 0.05）。其中，Tmsv16-SD对CRT治疗后反应的预测性能最佳，敏感性为88.9%，特异性为80.0%，诊断临界值为6.19%。这种预测能力超过了传统指标QRS波宽度。
结论
RT-3DE能够准确预测CRT治疗后患者的反应，并显著有助于定量评估CRT治疗效果。
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