Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy
Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy
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DOI：
10.1161/01.cir.0000133276.45198.a5
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发表时间：
2004-07-06
期刊：
影响因子：
37.8
通讯作者：
Sanderson, JE
中科院分区：
文献类型：
--
作者：
Yu, CM;Fung, JWH;Sanderson, JE
背景-许多无创技术已被用于预测心脏再同步化治疗（CRT）对心力衰竭患者的有效性，特别是左心室（LV）反向重构。本研究比较了组织多普勒成像（TDI）和应变率成像（SRI）参数对接受CRT的患者左室反向重构的相对预测值，并检查了缺血性（n = 22）和非缺血性（n = 32）心力衰竭的潜在差异。方法与结果-在基线和3个月随访时进行TDI和SRI。比较基于心肌收缩峰值时间（Ts）和应变峰值时间（Tsr）的18个心室内和室间非同步参数，以及收缩后缩短（PSS）。在整个研究人群中观察到左室舒张末期和收缩末期体积减小和射血分数增加的逆转重构（均P < 0.001）。在缺血组（r = -0.65, P < 0.001）和非缺血组（r = -0.79, P < 0.001）中，12个左室段的Ts标准偏差（Ts- sd）是逆转重构的最有力预测因子。12个左室段的PSS仅在非缺血组（r = -0.64, P < 0.001）是良好的预测因子，而在缺血组（r = 0.32, P = NS）则不是。然而，SRI参数和室间不同步不能预测反向重构。多元回归分析独立参数为两组Ts-SD （P < 0.005）和非缺血组12个左室段PSS （P = 0.03）。Ts-SD的受试者工作特征曲线面积最大（0.94;CI = 0.88 ~ 1.00）。结论：Ts-SD是左室反向重构最有力的预测指标，对缺血性和非缺血性心力衰竭始终有效。然而，PSS仅对非缺血性发病机制有用，而SRI参数的作用尚未得到本研究的支持。
Background - A number of noninvasive techniques have been used to predict the effectiveness of cardiac resynchronization therapy (CRT) in heart failure patients, in particular left ventricular (LV) reverse remodeling. This study compared the relative predictive values of tissue Doppler imaging (TDI) and strain-rate imaging (SRI) parameters for LV reverse remodeling in patients who received CRT and examined for potential differences in ischemic (n = 22) and nonischemic (n = 32) heart failure.Methods and Results - TDI and SRI were performed at baseline and 3-month follow-up. Eighteen parameters of intraventricular and interventricular asynchrony based on the time to peak myocardial contraction (Ts) and time to peak strain rate (Tsr) were compared, along with postsystolic shortening (PSS). Reverse remodeling with reduction of LV end-diastolic and end-systolic volumes and gain in ejection fraction (all P < 0.001) was observed in the whole study population. The standard deviation of Ts of 12 LV segments (Ts-SD) is the most powerful predictor of reverse remodeling in both the ischemic (r = -0.65, P < 0.001) and nonischemic (r = -0.79, P < 0.001) groups. The PSS of 12 LV segments was a good predictor only for the nonischemic (r = -0.64, P < 0.001) but not the ischemic (r = 0.32, P = NS) group. However, parameters of SRI and interventricular asynchrony failed to predict reverse remodeling. By multiple regression analysis, independent parameters included Ts-SD in both groups (P < 0.005) and PSS of 12 LV segments in the nonischemic group (P = 0.03). The area of the receiver operating characteristic curve was largest for Ts-SD (0.94; CI = 0.88 to 1.00).Conclusions - Ts-SD is the most powerful predictor of LV reverse remodeling and was consistently useful for ischemic and nonischemic heart failure. However, PSS is useful only for nonischemic pathogenesis, whereas the role of SRI parameters was not supported by the present study.