左心室之外：心脏再同步治疗后双心室同步性的三维超声心动图分析
Beyond the left ventricle: three-dimensional echocardiographic analysis of biventricular synchronization after cardiac resynchronization therapy.
作者信息
Okada Hisashi, Kikuchi Shohei, Sakurai Yomei, Hayashi Kosuke, Kayama Kiyomi, Shintani Yasuhiro, Kawada Yu, Mizoguchi Tatsuya, Yokoi Masashi, Yamabe Sayuri, Mori Kento, Ito Tsuyoshi, Kitada Shuichi, Goto Toshihiko, Seo Yoshihiro
机构信息
Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 4678601, Japan.
出版信息
J Echocardiogr. 2025 Jul 28. doi: 10.1007/s12574-025-00700-3.
BACKGROUND
Cardiac resynchronization therapy (CRT) aims to improve intraventricular dyssynchrony, but the impact on interventricular dyssynchrony remains unclear. This study investigates biventricular mechanical synchronization under different CRT pacing configurations using three-dimensional speckle-tracking echocardiography (3D-STE).
METHODS
We analyzed 22 heart failure patients with CRT implantation using 3D-STE under four pacing modes: Own/right ventricular pacing (Own/RV pacing), simultaneous biventricular pacing (LVRV pacing), biventricular pacing with 30 ms left ventricular (LV) lead preactivation (LV30RV pacing), and LV only pacing (LV pacing). Activation imaging (AI) quantified mechanical propagation, comparing mean AI differences between both ventricles (LV-RV difference), and the standard deviation of AI (AI-SD) for each region to assess the interventricular dyssynchrony and dispersion of mechanical propagation.
RESULTS
LV-RV difference was greater in Own/RV pacing than in LVRV pacing, LV30RV pacing and LV pacing (p = 0.12, 0.016, 0.009, respectively), indicating the prominent interventricular dyssynchrony. (LV-RV difference: Own/RV pacing: 41.1 ± 32.3 ms, LVRV pacing: 22.6 ± 29.2 ms, LV30RV pacing: 2.4 ± 38.5 ms, LV pacing: 17.8 ± 37.7 ms). In LVRV and LV30RV pacing, the AI-SD for both ventricles was significantly reduced compared to Own/RV pacing and LV pacing (p = 0.002, 0.005, 0.015, 0.002, respectively), indicating that biventricular pacing improved dyssynchrony in both ventricles (Own/RV pacing AI-SD: 57.1 ± 17.3, LVRV pacing AI-SD: 44.7 ± 12.7, LV30RV pacing AI-SD 47.0 ± 16.1, LV pacing AI-SD: 58.0 ± 17.0).
CONCLUSIONS
3D-STE provides a comprehensive assessment of biventricular mechanical propagation, revealing that LVRV and LV30RV pacing improve both intraventricular and interventricular synchrony. Incorporating RV mechanics into CRT optimization may enhance patient selection and treatment outcomes.
背景
心脏再同步治疗（CRT）旨在改善心室内不同步，但对心室间不同步的影响仍不明确。本研究使用三维斑点追踪超声心动图（3D-STE）调查不同CRT起搏配置下的双心室机械同步情况。
方法
我们使用3D-STE在四种起搏模式下分析了22例植入CRT的心力衰竭患者：自身/右心室起搏（自身/右心室起搏）、双心室同步起搏（左室右室同步起搏）、左心室起搏导线提前30毫秒的双心室起搏（左室30右室起搏）和仅左心室起搏（左心室起搏）。激活成像（AI）量化机械传导，比较两心室之间的平均AI差异（左室-右室差异），以及每个区域的AI标准差（AI-SD），以评估心室间不同步和机械传导的离散度。
结果
自身/右心室起搏时的左室-右室差异大于左室右室同步起搏、左室30右室起搏和左心室起搏（p值分别为0.12、0.016、0.009），表明心室间不同步明显。（左室-右室差异：自身/右心室起搏：41.1±32.3毫秒，左室右室同步起搏：22.6±29.2毫秒，左室30右室起搏：2.4±38.5毫秒，左心室起搏：17.8±37.7毫秒）。在左室右室同步起搏和左室30右室起搏时，与自身/右心室起搏和左心室起搏相比，两心室的AI-SD均显著降低（p值分别为0.002、0.005、0.015、0.002），表明双心室起搏改善了两心室的不同步情况（自身/右心室起搏AI-SD：57.1±17.3，左室右室同步起搏AI-SD：44.7±12.7，左室30右室起搏AI-SD：47.0±16.1，左心室起搏AI-SD：58.0±17.0）。
结论
3D-STE可对双心室机械传导进行全面评估，显示左室右室同步起搏和左室30右室起搏可改善心室内和心室间同步性。将右心室力学纳入CRT优化可能会改善患者选择和治疗效果。
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