心力衰竭患者存活心肌与心脏再同步化治疗响应的关系

Relationship between myocardial viability in stress echocardiography and response to cardiac resynchronization therapy in patients with heart failure

目的利用负荷三维超声心动图检测心力衰竭患者心肌的存活性,探讨心力衰竭患者存活心肌与心脏再同步化治疗(cardiac resynchronization therapy,CRT)响应的关系。方法心力衰竭患者28例,CRT术前检测心脏同步性参数(左、右心室同步性和左心室内同步性参数),同时于术前一周行药物多巴酚丁胺负荷超声试验(DSE),CRT术后复查超声心动图检测心力衰竭患者的CRT响应。结果 28例心力衰竭患者中,17例(61%)CRT术后存在响应,CRT响应组存活心肌患者比例[88%(15/17)vs.18%(2/11),P<0.001]、存活心肌的节段数[(9.2±2.3)节vs(3.4±1.9)节,P<0.001]与CRT无响应组比较,差异有统计学意义。对照同步性参数,两组左、右心室收缩延迟差值[(73±24)ms vs.(46±22)ms,P=0.005]、左心室内同步性参数左心室短轴各个节段径向应变峰值延迟最大差值(RS)[(212±81)ms vs.(147±62)ms,P=0.032]、四腔心切面各个节段横向应变峰值延迟最大差值(TS)[(219±84)ms vs.(160±63)ms,P=0.044]比较,差异有统计学意义。结论心力衰竭患者存活心肌的存在对CRT的响应起重要作用,在分析心脏同步性的同时,心肌的存活性也是一个预测心力衰竭患者CRT响应的重要指标。

Objectives Three-dimensional dobutamine stress echocardiography was used to assess myocardial viability in patients with heart failure. The aim of this study was to evaluate the role of myocardial viability in predicting response to cardiac resynchronization therapy（CRT） in patients with heart failure. Methods Twenty-eight patients with heart failure were selected. Echocardiographic techniques were used to measure interventricular and intraventricular dyssynchrony before CRT. Meanwhile, three-dimensional dobutamine stress echocardiography（DSE） was performed to determine myocardial viability one week before pacing implantation. Global functional recovery and detection of viable myocardium were identified if left ventricular ejection fraction（EF） had improved by 5% in 3D echocardiography.Follow-up echocardiography was performed 6 to 12 months after CRT. Response to CRT was defined by a 5-point scale in EF after CRT. Results During the follow-up period after CRT, 17 patients（61%） were responders, as defined by a 5-point scale in EF after CRT. The parameters between responders and non-responders were as follows ： patients with viable myocardium [88%（15 / 17） vs. 18%（2 / 11）, P〈0.001 ]; numbers of viable myocardial segments [（9.2 ±2.3）vs.（3.4±1.9）, P〈0.001 ]; interventricular mechanical delay [（73±24） ms vs.（46±22） ms, P=0.005 ]; opposing wall delay of short-axis radial strain（RS） [（212 ±81） ms vs.（147 ±62） ms, P =0.032 ]; and opposing wall delay of transverse strain（TS） in apical views with intraventricular dyssynchrony [（219 ±84） ms vs.（160 ±63） ms, P =0.044 ].The differences were significant. Conclusions Three-dimensional dobutamine stress echocardiography may have an important role in identifying CRT responders and the presence of viable myocardium is a stronger predictor of response to CRT compared with left ventricular mechanical dyssynchrony.