Value of Myocardial Work Estimation in the Prediction of Response to Cardiac Resynchronization Therapy
Value of Myocardial Work Estimation in the Prediction of Response to Cardiac Resynchronization Therapy
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DOI：
10.1016/j.echo.2017.10.009
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发表时间：
2018-02-01
影响因子：
6.5
通讯作者：
Donal, Erwan
中科院分区：
文献类型：
--
作者：
Galli, Elena;Leclercq, Christophe;Donal, Erwan
背景：心力衰竭的心脏再同步化治疗（CRT）受到太多无应答者的困扰。本研究的目的是评估是否由压力抑制环（PSLs）的心肌性能的估计是有用的选择CRT candidate.Methods：97例接受CRT的患者被纳入本研究。在CRT前和6个月随访（FU）时进行二维和斑点追踪超声心动图检查。传统的不同步参数进行了评价。左心室（LV）的建设性工作（CW）和浪费的工作（WW）估计的PSLs。CRT阳性反应（CRT+）定义为FU时LV收缩末期容积减少>= 15%，在63例（65%）患者中观察到。CW的添加> 1，057 mm Hg%（曲线下面积，0.72，P < .0001）和WW > 384 mm Hg%（曲线下面积，0.67，P = .005）与基线模型，包括临床，超声心动图，而传统的不同步参数显著增加了模型的功效（卡方（2），25.11 vs 47.5，P <0.0001）。在该模型中，间隔闪光（比值比[OR] = 2.78; P = .001）、CW > 1，057 mm Hg%（OR = 9.49; P = .002）和WW > 384 mm Hg%（OR = 16.24，P < .006）仍然是与CRT+相关的唯一参数。CW > 1,057 mm Hg%和WW > 384 mm Hg%的组合显示了良好的特异性（100%）和阳性预测值（100%），但对CRT+的识别的敏感性（22%）、阴性预测值（41%）和准确性（49%）较低。虽然这些参数不能被自己用来选择CRT的候选人，他们可以提供进一步的见解的理解不同步机制，并有助于提高CRT反应者的识别。
Background: Cardiac resynchronization therapy (CRT) in heart failure is plagued by too many nonresponders. The aim of the present study is to evaluate whether the estimation of myocardial performance by pressurestrain loops (PSLs) is useful for the selection of CRT candidates.Methods: Ninety-seven patients undergoing CRT were included in the study. Bidimensional and speckle-tracking echocardiography were performed before CRT and at the 6-month follow-up (FU). Conventional dyssynchrony parameters were evaluated. Left ventricular (LV) constructive work (CW) and wasted work (WW) were estimated by PSLs. Positive response to CRT (CRT+) was defined as >= 15% reduction in LV end-systolic volume at FU and was observed in 63 (65%) patients.Results: The addition of CW > 1,057 mm Hg% (area under the curve, 0.72, P < .0001) and WW > 384 mm Hg% (area under the curve, 0.67, P = .005) to a baseline model including clinical, echocardiographic, and conventional dyssynchrony parameters significantly increased the model power (chi(2), 25.11 vs 47.5, P < .0001). In this model, septal flash (odds ratio [OR] = 2.78; P = .001), CW > 1,057 mm Hg% (OR = 9.49; P = .002), and WW > 384 mm Hg% (OR = 16.24, P < .006) remained the only parameters associated with CRT+. The combination of CW > 1,057 mm Hg% and WW > 384 mm Hg% showed a good specificity (100%) and positive predictive value (100%) but a low sensitivity (22%), negative predictive value (41%), and accuracy (49%) for the identification of CRT+.Conclusions: The estimation of CW and WW by PSLs is a novel tool for the assessment of CRT patients. Although these parameters cannot be used by their own to select CRT candidates, they can provide further insights into the comprehension of dyssynchrony mechanisms and contribute to improving the identification of CRT responders.