Intra-left ventricular electromechanical asynchrony -: A new independent predictor of severe cardiac events in heart failure patients
Intra-left ventricular electromechanical asynchrony -: A new independent predictor of severe cardiac events in heart failure patients
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DOI：
10.1016/j.jacc.2003.08.038
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发表时间：
2004-01-21
影响因子：
24
通讯作者：
Roudaut, R
中科院分区：
文献类型：
--
作者：
Bader, H;Garrigue, S;Roudaut, R
我们试图评估的机电参数，使用组织多普勒超声心动图，作为潜在的独立预测心力衰竭（HF）恶化。背景心室传导障碍恶化HF患者的预后。然而，QRS宽度和形态，血流动力学参数，左室（LV）和心室间（V）收缩的存在和大小之间的关系尚未得到很好的澄清。进行超声心动图结合组织多普勒成像，并随访一年。方案分析了HF恶化的发生率（因心脏失代偿而住院）。前、间隔、下和外侧LV壁的V间和区域机电延迟与QRS形态和持续时间相关。将这些患者的左心室内和心室间不同步值与按性别和年龄标准匹配的健康受试者进行比较，以确定各自的正常范围。结果左心室内（但不是心室间）不同步的存在被确定为严重心脏事件的独立预测因素（风险比3.39，p < 0.0001），与左室射血分数和QRS宽度无关。在QRS宽度< 120英寸的患者中（55%; n = 57），56%的患者表现为严重的左室内心律失常，12%的患者表现为左室间心律失常。左束支分支传导阻滞患者中观察到84%的左室内血栓，右束支分支传导阻滞患者中也观察到83%的左室内血栓（p = NS）。QRS宽度与左心室内或左心室间收缩相关性较差（r = 0.36，p = NS和r = 0.43，p = 0.05）。结论：在无心肌梗死的心衰患者中，左心室内收缩的患者发生心脏事件的危险性显著增高，与QRS宽度和LVEF无关。因此，应更积极地识别此类患者，以便进行早期强化治疗和调查。(C)2004年，美国心脏病学会基金会。
OBJECTIVES We sought to assess the electromechanical parameters, using tissue Doppler echocardiography, as potential independent predictors of heart failure (HF) worsening.BACKGROUND Ventricular conduction disorders worsen the prognosis for HF patients. However, the relationships between the QRS width and morphology, hemodynamic parameters, and presence and magnitude of intra-left ventricular (LV) and inter-ventricular (V) asynchrony have not been well clarified.METHODS A total of 104 patients with an LV ejection fraction (EF) less than or equal to45% and stabilized HF, without myocardial infarction (MI), underwent echocardiography coupled with tissue Doppler imaging and were followed for one year. The protocol analyzed the incidence of worsening HF (hospitalization for cardiac decompensation). Inter-V and regional electromechanical delays for the anterior, septal, inferior, and lateral LV walls were correlated with the QRS morphology and duration. The intra-LV and inter-V asynchrony values of these patients were compared with those of healthy subjects matched by gender and age criteria to determine the respective normal ranges.RESULTS The presence of intra-LV (but not inter-V) asynchrony was identified as an independent predictor of severe cardiac events (hazard ratio 3.39, p < 0.0001), independent of the LVEF and QRS width. Of patients with a QRS width < 120 ins (55%; n = 57), 56% presented with major intra-LV asynchrony and 12% with inter-V asynchrony. Intra-LV asynchrony was observed in 84% of left bundle branch block patients, but also in 83% of right bundle branch block patients (p = NS). There was a poor correlation between the QRS width and intra-LV or inter-V asynchrony (r = 0.36, p = NS and r = 0.43, p = 0.05, respectively).CONCLUSIONS In HF patients without MI, patients with intra-LV asynchrony are those with a significantly higher risk of cardiac events, independent of the QRS width and LVEF. Accordingly, such patients should be more actively identified for early intensive treatment and survey. (C) 2004 by the American College of Cardiology Foundation.