Combined Longitudinal and Radial dyssynchrony predicts ventricular response after resynchronization therapy
Combined Longitudinal and Radial dyssynchrony predicts ventricular response after resynchronization therapy
复制标题
DOI：
10.1016/j.jacc.2007.06.043
复制
发表时间：
2007-10-09
影响因子：
24
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Gorcsan, John, III;Tanabe, Masaki;Bax, Jeroen J.
目的探讨超声心动图组织多普勒成像（TDI）和斑点追踪应变联合检测左室纵向运动不同步性和径向运动不同步性对预测心脏起搏治疗（CRT）后左室功能反应的可能性。方法对190例射血分数（EF）为23 ± 6%，QRS波时限为168 ± 27 ms的心力衰竭患者进行CRT治疗前后的对比研究。通过彩色TDI评估纵向不同步至峰值速度的时间（所有2个部位和67个亚组中的12个部位）。通过斑点追踪径向应变评估径向不同步性。LV反应被定义为EF增加>= 15%。结果176例患者（93%）在技术上有足够的基线和随访数据。总体而言，CRT后6 +/- 3个月时34%为EF无应答者。当2-部位TDI的纵向不同步（>= 60 ms）和径向不同步（>= 130 ms）均为阳性时，95%的患者有EF反应;当两者均为阴性时，21%的患者有EF反应（p < 0.001 vs.均为阳性）。当使用12位点TDI和径向应变不同步为阴性时，EF反应率最低（10%）（p < 0.001 vs.均为阳性）。当纵向或径向不同步是积极的（但不是两个），59%的EF反应。纵向和径向不同步联合预测EF反应的敏感性为88%，特异性为80%，显著优于单独使用任何一种技术（p < 0.0001）。结论纵向和径向不同步联合模式可预测CRT后左室功能反应。
Objectives The purpose of this study was to test the hypothesis that a combined echocardiographic assessment of longitudinal dyssynchrony by tissue Doppler imaging (TDI) and radial dyssynchrony by speckle-tracking strain may predict left ventricular (LV) functional response to cardiac resynchronization therapy (CRT).Background Mechanical LV dyssynchrony is associated with response to CRT; however, complex patterns may exist.Methods We studied 190 heart failure patients (ejection fraction [EF] 23 +/- 6%, QRS duration 168 +/- 27 ms) before and after CRT. Longitudinal dyssynchrony was assessed by color TDI for time to peak velocity (2 sites in all and 12 sites in a subgroup of 67). Radial dyssynchrony was assessed by speckle-tracking radial strain. The LV response was defined as >= 15% increase in EF.Results One hundred seventy-six patients (93%) had technically sufficient baseline and follow-up data available. Overall, 34% were EF nonresponders at 6 +/- 3 months after CRT. When both longitudinal dyssynchrony by 2-site TDI (>= 60 ms) and radial dyssynchrony (>= 130 ms) were positive, 95% of patients had an EF response; when both were negative, 21% had an EF response (p < 0.001 vs. both positive). The EF response rate was lowest (10%) when dyssynchrony was negative using 12-site TDI and radial strain (p < 0.001 vs. both positive). When either longitudinal or radial dyssynchrony was positive (but not both), 59% had an EF response. Combined longitudinal and radial dyssynchrony predicted EF response with 88% sensitivity and 80% specificity, which was significantly better than either technique alone (p < 0.0001).Conclusions Combined patterns of longitudinal and radial dyssynchrony can be predictive of LV functional response after CRT.