It's time for a paradigm shift in the quantitative evaluation of left ventricular dyssynchrony.
It's time for a paradigm shift in the quantitative evaluation of left ventricular dyssynchrony.
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现在是左心室不同步定量评估范式转变的时候了。
DOI：
10.1016/j.echo.2009.04.012
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Oshinski,JohnN
中科院分区：
文献类型：
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作者：
Fornwalt,BrandonK;Delfino,JanaG;Sprague,WilliamW;Oshinski,JohnN
1925年，卡尔·威格斯（Carl wiggers）首次描述了左心室（LV）非同步化对心脏功能的急性不良影响。近年来，由于心脏再同步化治疗（CRT）的出现，在QRS间期明显延长的情况下治疗严重左室功能障碍导致的心力衰竭，准确诊断左室非同步化已成为众多出版物关注的焦点2 - 4。在CRT最初的大型临床试验中，QRS持续时间被用作非同步化的衡量标准，以选择接受治疗的患者2,3。然而，QRS持续时间预测CRT疗效的敏感性和特异性均低于最佳水平。随后，许多直接基于左室壁运动的“峰值时间”参数被开发出来，用于超声心动图诊断左室机械非同步化，试图改善CRT的选择标准7。超声心动图机械非同步化参数最初在单中心研究中显示有希望预测对CRT的反应8 - 12。然而，多中心对CRT反应的预测因子（PROSPECT）研究最近报道，超声心动图非同步化参数不能被推荐用于改善患者对CRT的选择，超出目前的指南13。此外，窄QRS再同步治疗（RETHINQ）试验最近报道，窄QRS和机械非同步化证据的患者不能从CRT14中获益。
The acute adverse effects of left ventricular (LV) dyssynchrony on cardiac performance were first described in 1925 by Carl Wiggers1. In recent years, the accurate diagnosis of LV dyssynchrony has become the focus of a myriad of publications, driven by the advent of cardiac resynchronization therapy (CRT) to treat heart failure due to severe LV dysfunction in the setting of marked prolongation of the QRS interval2–4. In the initial large clinical trials of CRT, QRS duration was used as a measure of dyssynchrony to select patients for treatment2, 3. However, sensitivity5 and specificity6 of QRS duration to predict response to CRT were less than optimal. Subsequently, numerous “time-to-peak” parameters based directly on the motion of the LV walls were developed to diagnose LV mechanical dyssynchrony with echocardiography in an attempt to improve CRT selection criteria7.Echocardiographic mechanical dyssynchrony parameters initially showed promise in predicting response to CRT in single-center studies8–12. However, the multicenter Predictors of Response to CRT (PROSPECT) study recently reported that no echocardiographic dyssynchrony parameter could be recommended to improve patient selection for CRT beyond current guidelines13. In addition, the Resynchronization Therapy in Narrow QRS (RETHINQ) trial recently reported that patients with narrow QRS and evidence of mechanical dyssynchrony do not benefit from CRT14.