Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy.
Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy.
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心肌收缩效率的斑点追踪超声心动图分析可预测心脏再同步治疗的反应
DOI：
10.1186/s12947-018-0148-5
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发表时间：
2018-11-19
影响因子：
1.9
通讯作者：
Shu X
中科院分区：
文献类型：
--
作者：
Fulati Z;Liu Y;Sun N;Kang Y;Su Y;Chen H;Shu X
在左心室（LV）不同步的患者中，由于不适当的收缩时机，未落入射血期（LVEj）的收缩导致能量浪费，目前广泛采用心脏起搏治疗（CRT）。心肌收缩效率定义为LVEj期间的有效收缩时间（ECTR）和有效收缩幅度（ECR）与整个心动周期的比值。本研究前瞻性地调查了效率指标是否可以预测CRT的结果。采用斑点追踪超声心动图（STE）检测70例CRT患者的心肌收缩时间和收缩力参数，并计算效率指数。主要结局事件定义为死亡或HF住院，次要结局事件定义为随访期间的全因死亡。16-以应变起效时间标准差（TTO-16 SD）和应变达峰时间标准差（TTP-16 SD）作为非同步性指标。根据6个月随访时的左室收缩末期容积（LVESV）和左室射血分数（LVEF）值，将受试者分为应答组和非应答组，ECR（OR 0.87，95%CI 0.78-0.97，P < 0.05）和最大纵向应变（MLS）（OR 2.22，95%CI 1.36-3.61，P < 0.01）是CRT反应的两个独立预测因素，TTO-16 SD和TTP-16 SD均不能预测疗效。心肌收缩效率差、收缩力好的患者更可能从CRT中获益。STE可评价左室收缩效率和收缩力，预测CRT反应。当通过STE分析心肌应变时，应突出显示LVEj期间的收缩。
In patients with left ventricular (LV) dysssynchrony, contraction that doesn’t fall into ejection period (LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by cardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient Contraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac cycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome. Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing and contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated accordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization, and secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of time to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes. According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up, subjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78–0.97, P < 0.05) and maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36–3.61, P < 0.01) were the two independent predictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer myocardial contraction efficiency and better contractility are more likely to benefit from CRT. STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response. When analyzing myocardial strain by STE, contraction during LVEj should be highlighted.
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影响因子：
37.8
作者：
Lim, Pascal;Buakhamsri, Adisai;Grimm, Richard A.
通讯作者：
Grimm, Richard A.
影响因子：
5.5
作者：
Eschalier, Romain;Ploux, Sylvain;Bordachar, Pierre
通讯作者：
Bordachar, Pierre
影响因子：
37.8
作者：
Delgado, Victoria;van Bommel, Rutger J.;Bax, Jeroen J.
通讯作者：
Bax, Jeroen J.
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
DOI：
10.1016/j.echo.2017.10.009
发表时间：
2018-02-01
影响因子：
6.5
作者：
Galli, Elena;Leclercq, Christophe;Donal, Erwan
通讯作者：
Donal, Erwan