Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography
Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography
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DOI：
10.1016/j.jcmg.2008.07.014
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发表时间：
2008-11-01
影响因子：
14
通讯作者：
Hoffmann, Udo
中科院分区：
文献类型：
--
作者：
Truong, Quynh A.;Singh, Jagmeet P.;Hoffmann, Udo
结论：我们试图确定心脏计算机断层扫描（CT）检测左心室不同步的程度在宽QRS的心力衰竭（HF）患者，窄QRS的HF患者，和年龄匹配的controls.Background的机械不同步的程度的显着差异的可行性已被建议作为一个预测心脏起搏治疗的反应。有没有发表的报告，不同步评估与使用CT.METHODS 38例受试者进行心电图门控对比增强64层多排CT。左心室内膜和心外膜的边界从短轴图像重建在10%的心动周期的相位增量划定。使用随时间推移的室壁厚度、室壁运动和容积变化评估整体和节段CT不同步度量的再现性。我们定义了一个整体的度量标准，使用壁厚的变化作为不同步指数（DI）。（观察者间和观察者内组内相关系数>= 0.94，p < 0.0001），并用于确定3组之间的差异：HF宽QRS组（射血分数[EF] 22 +/-8%，QRS 163 +/- 28 ms）、HF窄QRS组（EF 26 +/-7%，QRS 96 +/- 11 ms）和年龄匹配的对照受试者（EF 64 +/-5%，QRS 87 +/- 9 ms）。3组之间的平均DI有显著差异（HF宽QRS：152 +/- 44 ms，HF窄QRS：121 +/- 58 ms，对照受试者：65 +/- 12 ms; p < 0.0001），HF宽QRS（p < 0.0001）和HF窄QRS（p = 0.005）组与对照受试者相比更大。我们发现，DI与二维（r = 0.65，p = 0.012）和三维（r = 0.68，p = 0.008）超声心动图不同步。结论：基于随时间推移的壁厚变化，是高度可重复的，并且在最可能具有不同步的受试者和年龄匹配的对照受试者之间呈现显著差异。（美国科尔心脏病学杂志2008; 1：772-81）（C）美国心脏病学会基金会2008年
OBJECTIVES We sought to determine the feasibility of cardiac computed tomography (CT) to detect significant differences in the extent of left ventricular dyssynchrony in heart failure (HF) patients with wide QRS, HF patients with narrow QRS, and age-matched controls.BACKGROUND The degree of mechanical dyssynchrony has been suggested as a predictor of response to cardiac resynchronization therapy. There have been no published reports of dyssynchrony assessment with the use of CT.METHODS Thirty-eight subjects underwent electrocardiogram-gated contrast-enhanced 64-slice multidetector CT. The left ventricular endocardial and epicardial boundaries were delineated from short-axis images reconstructed at 10% phase increments of the cardiac cycle. Global and segmental CT dyssynchrony metrics that used changes in wall thickness, wall motion, and volume over time were assessed for reproducibility. We defined a global metric using changes in wall thickness as the dyssynchrony index (DI).RESULTS The DI was the most reproducible metric (interobserver and intraobserver intraclass correlation coefficients >= 0.94, p < 0.0001) and was used to determine differences between the 3 groups: HF-wide QRS group (ejection fraction [EF] 22 +/- 8%, QRS 163 +/- 28 ms), HF-narrow QRS (EF 26 +/- 7%, QRS 96 +/- 11 ms), and age-matched control subjects (EF 64 +/- 5%, QRS 87 +/- 9 ms). Mean DI was significantly different between the 3 groups (HF-wide QRS: 152 +/- 44 ms, HF-narrow QRS: 121 +/- 58 ms, and control subjects: 65 +/- 12 ms; p < 0.0001) and greater in the HF-wide QRS (p < 0.0001) and HF-narrow QRS (p = 0.005) groups compared with control subjects. We found that DI had a good correlation with 2-dimensional (r = 0.65, p = 0.012) and 3-dimensional (r = 0.68, p = 0.008) echocardiographic dyssynchrony.CONCLUSIONS Quantitative assessment of global CT-derived DI, based on changes in wall thickness over time, is highly reproducible and renders significant differences between subjects most likely to have dyssynchrony and age-matched control subjects. (J Am Coll Cardiol Img 2008; 1:772-81) (C) 2008 by the American College of Cardiology Foundation