左心室瘢痕负荷SPECT相位分析法检测及其对心脏再同步治疗疗效的影响

Impact of left ventricular scar burden and cardiac synchrony on cardiac resynchronization therapy efficacy

目的观察慢性心力衰竭患者心脏再同步治疗（CRT）后有反应和无反应者之间左心室瘢痕负荷的差异性，评价左心室瘢痕负荷对CRT疗效的影响。方法对30例2006年至2010年因慢性心力衰竭在南京医科大学第一附属医院接受CRT的患者进行静息核素心肌显像检查，应用相位分析技术检测左心室瘢痕负荷、收缩期相位时间标准差（phaseSD）和带宽（BW）并用来评价心脏同步性。以术后6个月超声心动图的检测结果及随访6个月内是否因心力衰竭住院作为分组标准，左心室射血分数（LVEF）提高t〉0．05且无因心力衰竭住院的患者入选反应组，LVEF提高〈0．05或者入院1次以上的患者入选无反应组，观察两组之间左心室瘢痕负荷和同步性指标之间的差异。结果30例患者中反应组19例（男8例），无反应组11例（男8例）。两组之间术前临床资料相似，年龄、性别均差异无统计学意义；有反应组术前QRS时限显著大于无反应组（（163．O±7．7）InS对（134．6±11．8）Ills，P〈O．05]；两组术前LVEF差异无统计学意义，但术后有反应组显著高于无反应组（0．49±0．02对0．33＋0．15，P〈0．01）。两组患者左心室瘢痕负荷和CRT术后左心室同步性差异具有统计学意义，有反应组患者的左心室瘢痕负荷明显低于无反应组（24．6％±3．6％对36．5％±3．9％，P=0．022）；有反应组左心室同步性较好，收缩期相位时间标准差明显小于无反应组（28．1±4．4。对56．1。±6．9。，P〈0．01），收缩期带宽明显小于无反应组（88．0。±13．9。对170．1。±24．4。，P〈0．01）。左心室瘢痕负荷和心脏同步性对CRT疗效具有明显的影响。结论接受CRT的慢性心力衰竭患者，左心室瘢痕负荷和CRT术后心脏同步性与CRT疗效密切相关。

Objective This study was to assess the impact of left ventricular scar burden and cardiac synchrony on cardiac resynchronization therapy （CRT） efficacy. Methods We retrospectively analysed the left ventrieular scar burden and cardiac synchrony postCRT assessed by singlephoton emission computed tomography（SPECT） in 30 CRT patients. They were divided into CRTresponse group （19 pts,8 males） and CRT- nonresponse group （11 pts, 8males）. The CRT responder was defined as the improvement of left ventricular ejection fraction （LVEF） more than 0. 05 and no admission to hospital during the first 6 months after CRT. The CRT nonresponder was defined as the improvement of LVEF less than 0.05 or at least one time unscheduled admission to hospital during the first 6 months after CRT. The left ventricular scar burden and cardiac synehrony were determined by SPECT myocardial perfusion. The cardiac synchrony parameters include phase SD and bandwidth. LVEF was detected by eehocardiography. Results There was significant difference in cardiac synehronyand scar burden between two groups. The average of phase SD and bandwidth was 28. 1 ±4. 4° and 88.0°± 13.9° in response group,and 56. 1°±6. 9° and 170. 1°±24. 4°in nonresponse group （P〈0. 01 ）. The scar burden was 24. 6% ±3.6% and 36.5%± 3.9% in response group and nonresponse group,respectively （ P〈0. 05 ）. Conclusion CRT efficacy is associated with cardiac synchrony and myocardial scar burden assessed by SPECT,which may provide identified of CRT responders.