常用临床和超声指标对心脏再同步化治疗效果的预测价值

Predictive value of clinical and echocardiographic parameters on cardiac resynchronization therapy

目的评价常用超声指标、血清氨基末端脑钠素前体(NT-proBNP)及QRS波时限(QRSd)在预测心脏再同步化治疗(CRT)效果中的价值。方法选择因难治性心力衰竭行CRT治疗的患者80例,于术前及术后6个月行超声心动图检查,获取常规二维超声参数、同步性参数;于术前及术后7d完善血清NT-proBNP及心电图QRSd检测。以治疗后6个月左心室收缩末期容积较术前减小≥15%为治疗有效。结果术前同步化指数(Ts-12SD)对CRT疗效有预测价值(AUC=0.703,P=0.019;Ts-12SD≥34.6ms时敏感度及特异度分别为61.8%和70.6%),余同步性指标对CRT疗效无预测价值(P>0.05)。术前NT-proBNP水平对CRT疗效亦有预测价值(AUC=0.75,P=0.005)。术前QRSd对CRT疗效无预测价值(P>0.05)。结论常用超声心动图指标中,仅Ts-12SD能预测CRT疗效。术前NT-proBNP水平对CRT疗效有一定的预测价值,而术前QRSd不能预测CRT疗效。

Objective To assess the value of echocardiographic parameters,N-terminal pro-brain natriuretic peptide（NT-proBNP）,and the duration of QRS wave（QRSd）in predicting the response to cardiac resynchronization therapy（CRT）.Methods Eighty patients accepted CRT because of refractory heart failure were enrolled.Echocardiography was performed to acquire two-dimensional echocardiography parameters and to evaluate inter-and intra-ventricular dyssynchrony before and after 6 months of CRT.The concentration of NT-proBNP was detected and QRSd was measured before and after 7 days of CRT implantation.At least 15% reduction in LVESV at the 6-month after CRT was defined as responders.Results The standard deviation of time to peak myocardial systolic velocity of all 12 LV segments（Ts-12SD）is relatively valuable in predicting CRT responders（AUC=0.703,P =0.019;Ts-12SD≥34.6 ms has the relatively high sensitivity of 61.8% and specificity of 70.6%）,other synchrony parameters could not predict the response to CRT（NS）.The level of NT-proBNP before CRT implantation could predict the response to CRT（AUC=0.75,P=0.005）.The QRSd could not predict the response to CRT（NS）.Conclusions Only Ts-12SD of echocardiographic parameters which were usually used could predict the response to CRT.The level of NT-proBNP before CRT implantation is valuable in predicting the response to CRT.The QRSd could not predict the response to CRT.