常用超声指标不能预测心脏再同步化治疗的疗效

M-mode Echocardiography, pulsed-wave Doppler and tissue Doppler imaging failed to predict cardiac resynchronization therapy responders

目的比较和评价常用的M型超声、频谱多普勒和组织多普勒指标在预测心脏再同步化治疗（CRT）疗效中的价值。方法29例完成随访的CRT患者，评价心脏同步性的常用超声心动图参数包括室间隔与左室后壁间的收缩延迟时间（SPWMD）、肺动脉射血前时间（PPEI）、主动脉射血前时间（APEI）、速度达峰时间的标准差（Ts—SD）、心室间机械延迟（IVMD）。以CRT后6个月，左室收缩末容积较治疗前减小≥1（1％为治疗有效。结果CRT的有效率为68．97％。术后CRT无效组的SPWMD、PPEI、APEI和Ts—SD均无显著改变（均P〉0．05），CRT有效组的SPWMD、APEI和Ts－SD显著缩短（P〈0．05或P〈0.001），SPwMD、PPEI、APEI、Ts—SD和IVMD预测CRT疗效的ROC曲线下面积在0．41～0．57之间，且差异均无统计学意义（均P〉0．05）。结论常用的M型超声、频谱多普勒和组织多普勒指标均不能预测CRT疗效，有必要进行实时三维超声和斑点追踪显像等新技术参数预测CRT疗效的研究。

Objective To assess whether echocardiographic parameters of M mode, pulsed-wave Doppler and tissue Doppler imaging which were usually used for selecting cardiac resynchronization therapy （CRT） candidates could predict CRT responders. Methods Twenty-nine patients with NYHA class III or IV heart failure, left ventricular ejection fraction（LVEF） ≤ 35 %, QRS≥ 130 ms were enrolled. All of them underwent biventricular pacemaker implantation. The septal-to-posterior wall motion delay（SPWMD） from M mode recording,and the standard deviation of time to peak systolic velocity（Ts SD） were used to evaluate intraventricular dyssynchrony. The interventricular mechanical delay （ IVMD ） by pulsed Doppler echocardiography was calculated by subtracting the right ventricular preejection intervals （RV-PEI： the onset of the QRS on the electrocardiogram to the onset of pulmonary outflow） from the left ventricular preejection intervals （LV-PEI： the onset of the QRS on the electrocardiogram to the onset of aortic outflow）. At least 15 % reduction in left ventricular end systolic volume（LVESV） at the 6 month after CRT was defined as responder. Results In the 29 patients,there were 20 （68. 97%） responders. The area under the receiver operating curve （ROC） of SPWMD, Ts SD, LV PEI, RV PEI and IVMD to predict CRT responders was 0.448 （95% CI 0. 184- 0.712, P 〉0.05）,0.557 （95% CI 0.317- 0.798, P〉0. 05）, 0.479 （95% CI 0.186-0.773, P〉0.05）,0. 568 （95% CI 0.272-0.863, P〉0. 05） and 0.411 （95% CI 0. 136 - 0. 687, P 〉0.05）, respectively. Conclusions M-mode echocardiography, pulsed Doppler and tissue Doppler imaging failed to predict CRT responders. New echocardiographic techniques including threedimensional echocardiography and speckle tracking image will he investigated, and may improve the predictive power.