超声心动图预测心脏再同步化治疗超反应的价值

摘要

Objective To investigate the role of echocardiography in prognosticating super-responders (SR) to cardiac re-synchronization therapy (CRT). Methods Seventy-eight heart failure patients underwent echocardiography examination 7 days before and 1 year after CRT. Left ventricular end-diastolic dimension (LVEDD) , ejection fraction (LVEF) , mitral re-gurgitation area (MRA), and the ratio of mitral inflow early-diastolic to late-diastolic velocity (E/A) were measured. Meanwhile, LV synchrony index (SI) was detected using two-dimensional speckle tracking imaging. Patients with LVEF increase <5% were classified as non-responders (CRT-NR group) , LVEF increase ≥5% and LVEF <50% as responders (CRT-R group) , and those LVEF ≥50% were considered as super-responders (CRT-SR group) 1 year after CRT. Parameters among three groups were compared statistically. Results Twelve patients (12/78, 15. 38%) were classified as CRT-SR. Compared with CRT-NR group (19/78, 24. 36%), there were more left bundle branch block (LBBB) and dilated car-diomyopathy (DCM) in CRT-SR group, longer SI and smaller MRA and E/A. The ratio of DCM, ratio of LBBB, MRA and E/A were statistical different between CRT-SR group and CRT-R group (47/78, 60. 26%). Before CRT, the ratio of DCM and LBBB, MRA and E/A were correlated with super-responders (r=0. 51, 0. 40, -0. 38, -0. 32, all P<0. 01). Conclusion DCM patients with LBBB, smaller MRA and non-restrictive diastolic model tend to become super-responders after CRT.%目的 探讨超声心动图预测心脏再同步化治疗(CRT)超反应的价值.方法 对78例接受CRT术的慢性心力衰竭患者,分别于术前7天和术后1年行超声检查,测量左心室舒张末径(LVEDD)和射血分数(LVEF)、二尖瓣血流舒张早期(E)和舒张晚期速度(A),计算E/A和二尖瓣反流面积(MRA)；以二维斑点追踪技术检测左心室收缩同步性(SI).将CRT术后LVEF增加＜5％定义为无反应组(CRT-NR),LVEF增加≥5％但LVEF＜50％为CRT有反应组(CRT-R),LVEF≥50％为CRT超反应组(CRT-SR).对3组间各参数进行统计学比较.结果 术后12例为CRT-SR组(12/78,15.38％),其中扩张型心肌病(DCM)所占比例、左束支传导阻滞(LBBB)所占比例及其SI均大于CRT-NR组(19例,19/78,24.36％),MRA、E/A则小于CRT-NR组.CRT-SR组和CRT-R组(47例,47/78,60.26％)间DCM所占比例、LBBB所占比例、MRA和E/A差异有统计学意义.术前DCM所占比例、LBBB所占比例、MRA和E/A均与CRT超反应相关(r=0.51,0.40,-0.38,-0.32,P均＜0.01).结论 CRT术前DCM合并LBBB、MRA较小和非限制型舒张功能减低患者术后更易出现超反应.