左右心室收缩功能对心脏再同步化治疗效果的预测价值

Left and right ventricular longitudinal strains are predictors of reverse remodeling after cardiac resynchronization therapy

目的评价左右室收缩功能对心脏再同步化治疗（CRT）效果的预测价值。方法选取2011年1月1日~2015年5月31日因心功能不全在解放军总医院植入CRT的患者50例。收集患者的临床资料测定术前和术后6个月的超声心动图指标，测定指标包括左室长轴应变（LVSLS）、右室长轴应变（RVSLS）等。按照CRT的超声反应标准进行分组，分为CRT治疗有反应组（n=31）和无反应组（n=19）,首先通过单因素分析和多因素分析，分析VVI参数与CRT治疗效果的相关性，在此基础上进一步通过受试者工作特征曲线（ROC）分析得出各参数指标ROC下的面积（AUC）和截断点，再分别计算各参数单独和联合预测CRT有效性的灵敏度、特异度和准确度。结果①LVSLS、RVSLS与CRT治疗效果有相关性，多因素Logistic回归模型分析，发现LVSLS〔OR 3.45 CI（2.47-10.86）,P〈0.01〕，RVSLS〔OR 3.01 CI（1.98-4.66）,P〈0.01〕。②VVI参数预测价值部分，LVSLS 的AUC为0.722（P〈0.01），RVSLS的 AUC为0.703（P〈0.01），串联试验后AUC最大，为0.798（P〈0.01），选定的截断点分别为LVSLS〉9.7%,RVSLS〉16.8%。分别计算其灵敏度、特异度和准确度，LVSLS的上述指标分别是90%、42%和72%；RVSLS分别是87%、53%和74%；LVSLS和RVSLS串联试验分别是84%、68%和78%。结论左右心室收缩功能与CRT治疗效果有相关性，串联左右心室长轴峰值应变指标预测CRT治疗效果优于单一指标。

AIM To identify the strain echocardiographic parameters for predicting LV reverse remodeling after cardiac resynchronization therapy （CRT）. METHODS Fifty consecutive patients with heart failure for implantation of a biventricular pacemaker were enrolled. Echocardiographic and clinical data were collected at baseline and 6 months after implantation, including left ventricular systolic longitudinal strain （LVSLS） and right ventricular systolic longitudinal strain （RVSLS）. Patients were grouped according to echocardiographic response. Multivariable analysis was performed on significant parameters on the univariate analysis. Sensitivity and specificity of the best performing cutoff value for the parameters was determined using receiver operating characteristic curve analysis. These echocardiographic parameters were combined to predict LV reverse remodeling after CRT. RESULTS Baseline echocardiographic indexes of left ventricular systolic longitudinal strain （LVSLS） and right ventricular systolic longitudinal strain （RVSLS） were significantly more impaired in nonresponders vs. responders to CRT （P 〈 0. 01 ）. Multiple logistic analysis identified LVSLS [ OR 3.45 CI （2.47 - 10. 86） , P 〈 0.01 ] , RVSLS [ OR 3.01 CI （ 1.98 - 4. 66） , P 〈 0. 0 ] as the independent predictor of reverse remodeling after CRT. Cut-off values were defined as LVSLS 〉 9.7% with 90% sensitivity, 42% specificity and 72% accuracy, （AUC = 0.22, P 〈0. 01） and RVSLS 〉 16.8% with 87% sensitivity 53% specificity and 74% accuracy （AUC =0. 703, P 〈 0. 01 ）. Patients with baseline LVSLS 〉 9. 7% and RVSLS 〉 16. 8% were named both- responder. Others were named non-both-responder. Combined LVSLS and RVSLS predicted CRT response with 84% sensitivity, 68% specificity and 78% accuracy, which was significantly better than either technique alone （AUC = 0. 798, P 〈 0. 01 ）. CONCLUSION Left and right ventricular systolic function are associated with LV reverse remodeling after CRT. The combined echocardiographic parame- ters of left and fight ventricular longitudinal strain predict the outcomes more accurately than a single echocardiographic parameter.