Opposing wall mechanics are significantly influenced by longitudinal cardiac rotation in the assessment of ventricular dyssynchrony.
Opposing wall mechanics are significantly influenced by longitudinal cardiac rotation in the assessment of ventricular dyssynchrony.
复制标题
在心室不同步评估中，纵向心脏旋转对相对壁力学有显着影响。
DOI：
10.1016/j.jcmg.2008.12.022
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Grimm,RichardA
中科院分区：
文献类型：
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作者：
Phillips,KarenP;Popović,ZoranB;Lim,Pascal;Meulet,JohnE;Barrett,ConorD;DiBiase,Luigi;Agler,Deborah;Thomas,JamesD;Grimm,RichardA
目的本研究旨在评估纵向旋转 (LR) 是否影响心肌收缩速度分布，并将基于速度的不同步测量与 LR 进行比较，以预测心脏再同步治疗 (CRT) 反应。 是最近认识到的现象，也是 CRT 反应的新预测因素。方法 确定了 100 名植入 CRT 并具有合适基线超声心动图的患者。通过斑点追踪技术和基底隔膜的心肌收缩速度在心尖 4 腔视图中评估纵向旋转，并通过组织多普勒图像分析侧向 LV。分析 LR 分布四分位数的收缩速度差异。随访时进行了测量值与 LV 收缩末期容积 (ESV) 减少之间的相关性。结果四分位数 1 的平均 LR 为 -6.8 ± 2.3°；四分位数 4 显示平均 LR 为 2.3 ± 1.6°。与隔膜相比，在四分位数 1 中发现侧壁峰值速度降低 (p = 0.01)，而在四分位数 4 中则相反 (p = 0.0001)。发现间隔壁和侧壁之间峰值速度幅度的差异与 LR 模式以及非缺血患者随访时 LV ESV 降低百分比相关。间隔外侧延迟与 LR 的存在不相关，也不能预测 LV ESV 的降低。结论 顺时针 LR 突出的患者侧壁长轴收缩速度降低，而逆时针 LR 患者间隔壁速度降低。基底间隔和侧向收缩速度峰值幅度的差异可预测 LR，并且在非缺血亚组中与随访时定量 LV 逆重塑相关。基于时间的速度测量（包括间隔外侧延迟）不能预测 CRT 反应。
ObjectivesThis study sought to assess whether longitudinal rotation (LR) affects myocardial systolic velocity profiles and to compare velocity-based measures of dyssynchrony with LR for predicting cardiac resynchronization therapy (CRT) response.BackgroundLongitudinal rotation, a rocking motion often seen when the dilated left ventricle (LV) is imaged in its horizontal long-axis plane, is a recently recognized phenomenon and a new predictor of response to CRT.MethodsOne hundred patients with CRT implants and suitable baseline echocardiograms were identified. Longitudinal rotation was assessed in the apical 4-chamber view by speckle-tracking techniques and myocardial systolic velocities for basal septum, and lateral LV were analyzed from tissue Doppler images. The quartiles of LR distribution were analyzed for differences in their systolic velocities. Correlation between measurements and reduction in LV end-systolic volume (ESV) at follow-up was performed.ResultsQuartile 1 had a mean LR of −6.8 ± 2.3°; quartile 4 showed a mean LR of 2.3 ± 1.6°. A depressed peak velocity of lateral wall, when compared with the septum, was found for quartile 1 (p = 0.01), whereas the converse was noted in quartile 4 (p = 0.0001). The difference in amplitude of peak velocity between septal and lateral walls was found to correlate with the pattern of LR and with percentage reduction in LV ESV at follow-up in nonischemic patients. Septal–lateral delay was not correlated with the presence of LR, nor was it predictive of reduction in LV ESV.ConclusionsPatients with prominent clockwise LR have depressed long-axis systolic velocities of the lateral wall, whereas the patients with counterclockwise LR have depressed septal wall velocities. The difference in peak amplitude of basal septal and lateral systolic velocities is predictive of LR, and in the nonischemic subgroup correlates with quantitative LV reverse remodeling at follow-up. Velocity time-based measures, including septal–lateral delay were not predictive of CRT response.