Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study
Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study
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DOI：
10.1136/hrt.2006.095612
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发表时间：
2007-10-01
期刊：
影响因子：
5.7
通讯作者：
Hoffmann, Rainer
中科院分区：
文献类型：
--
作者：
Becker, Michael;Franke, Andreas;Hoffmann, Rainer
背景：心脏再同步化治疗（CRT）中最佳左心室导联位置的定义是需要的。目的：利用新型心肌变形显像确定CRT的最佳左室导联位置，并根据左室导联位置评价CRT的有效性。方法：采用二维超声心动图（EchoPAC， GE超声）对47例心衰患者在基线和CRT期间进行心肌形变成像。在36节段LV模型中，确定CRT前收缩周向应变的最新峰值节段。假设CRT前后收缩周应变峰值时间差最大的段为左室导联位置。最佳左室导联位置定义为在CRT前最近收缩的段与假定左室导联位置的段同时或紧邻。结果：最佳左室导联25例，非最佳左室导联22例。CRT前，最佳和非最佳左室导联位置患者的左室射血分数（EF）和峰值耗氧量（Vo(2)max）相似(平均（SD） EF = 31.4 (6.1)% vs 30.3 (6.5)%, Vo(2)max = 14.2 （1.8) vs 14.0 (2.1) ml/min/kg）。在CRT治疗3个月时，最佳和非最佳LV导联位置组的EF分别增加了9(2)%和5 (3)%,Vo(2)max分别增加了2.0（0.8）和1.1 (0.5)ml/min/kg （p均< 0.001）。结论：与非最佳左室导联位置相比，左室导联位置与CRT前最后一次收缩位置的一致性对EF和心肺负荷的改善更大。
Background: Definition of the optimal left ventricular (LV) lead position in cardiac resynchronisation therapy (CRT) is desirable.Objective: To define the optimal LV lead position in CRT and assess the effectiveness of CRT depending on the LV lead position using new myocardial deformation imaging.Methods: Myocardial deformation imaging based on tracking of acoustic tissue pixels in two-dimensional echocardiographic images (EchoPAC, GE ultrasound) was performed in 47 patients with heart failure at baseline and during CRT. In a 36-segment LV model the segment with the latest peak systolic circumferential strain before CRT was determined. The segment with maximal temporal difference in peak systolic circumferential strain on CRT compared with before CRT was assumed to be the LV lead position. The optimal LV lead position was defined as concurrence or immediate neighbouring of the segment with the latest contraction before CRT and those with assumed LV lead location.Results: 25 patients had optimal and 22 non-optimal LV lead positions. Before CRT, the LV ejection fraction (EF) and peak oxygen consumption (Vo(2)max) were similar in patients with optimal and non-optimal LV lead positions ( mean (SD) EF = 31.4 ( 6.1)% vs 30.3 (6.5)% and Vo(2)max = 14.2 (1.8) vs 14.0 (2.1) ml/min/kg, respectively). At 3 months on CRT, EF increased by 9 ( 2)% vs 5 ( 3)% and Vo(2)max by 2.0 (0.8) vs 1.1 (0.5) ml/min/kg in the optimal vs non-optimal LV lead position groups, respectively ( both p < 0.001).Conclusions: Concordance of the LV lead site and location of the latest systolic contraction before CRT results in greater improvement in EF and cardiopulmonary workload than the non-optimal LV lead position.