Color Doppler Tissue Velocity Imaging Can Disclose Systolic Left Ventricular Asynchrony Independent of the QRS Morphology in Patients with Severe Heart Failure
Color Doppler Tissue Velocity Imaging Can Disclose Systolic Left Ventricular Asynchrony Independent of the QRS Morphology in Patients with Severe Heart Failure
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DOI：
10.1111/j.1540-8159.2004.00464.x
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发表时间：
2004-04
期刊：
影响因子：
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通讯作者：
P. Schuster;S. Faerestrand;O. Ohm
中科院分区：
文献类型：
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作者：
P. Schuster;S. Faerestrand;O. Ohm
QRS宽度大于120 ms被认为是严重心力衰竭（HF）患者心室间和心室内非同步的标志。采用时间分辨率为10 ms的彩色多普勒组织速度成像（c‐TVI）研究左、右束支阻滞（LBBB和RBBB）及QRS宽度正常的HF患者局部左室（LV）纵向收缩模式。我们研究了12名女性和23名男性严重HF患者，平均年龄66±11岁，纽约心脏协会功能分级为2.9±0.6。20例患者有LBBB，其中10例接受双心室起搏（CRT）心脏再同步化治疗。10例QRS宽度正常，5例RBBB。在超声心动图顶端四室视图中，比较左室基底段和中左室段的区域组织峰值速度和区域组织峰值速度时间差。患者组间区域平均峰值组织速度无显著差异。在接受CRT治疗的LBBB患者中，左室基底侧自由壁运动在主收缩期延迟29 ms，与未接受CRT治疗的LBBB患者几乎有显著差异（P = 0.075）。即使在QRS宽度或RBBB正常的HF患者中，也观察到明显的异步左室纵向收缩。结论：对于重度心衰患者局部纵向左室收缩非同步性的检测，强烈建议采用体表心电图的辅助方法，如c‐TVI。（pace 2004; 27:46 - 467）
A QRS width greater than 120 ms is assumed to be a marker of inter‐ and intraventricular asynchrony in severe heart failure (HF) patients. Color Doppler tissue velocity imaging (c‐TVI) with a time resolution of 10 ms was used to study regional left ventricular (LV) longitudinal systolic contraction pattern in HF patients with left and right bundle branch block (LBBB and RBBB) and in patients with normal QRS width. We studied 12 women and 23 men with severe HF, with a mean age of 66 ± 11 years in New York Heart Association functional Class 2.9 ± 0.6. Twenty patients had LBBB and 10 of those were accepted for cardiac resynchronization therapy by biventricular pacing (CRT). Ten patients had normal QRS width, and five had RBBB. In the echocardiographic apical four chamber view, regional peak LV tissue velocities and regional LV time differences of peak tissue velocities were compared at basal and mid‐LV segments. There were no significant differences in regional mean peak tissue velocities among the patient groups. In patients with LBBB accepted for CRT, the LV lateral free‐wall movement at basal LV was 29 ms delayed during main systole, almost significantly different from LBBB patients not accepted for CRT (P = 0.075). Even in HF patients with normal QRS width or RBBB, significant asynchronous longitudinal LV contraction was observed. Conclusions: For the detection of regional longitudinal LV contraction asynchrony in patients with severe HF, supplementary methods to the surface ECG, such as c‐TVI, are strongly recommended. (PACE 2004; 27:460–467)