超声心动图预测心脏再同步化治疗超反应的价值  

Value of echocardiography in prognosticating super-responders to cardiac resynchronization therapy

作　　者：马春燕[1] 赵红[2] 刘爽[1] 张妍[1] 赵斓婷[1] 唐力[1] 于波[3] 杨军[1] 

机构地区：[1]中国医科大学附属第一医院心血管超声科,辽宁沈阳110001 [2]黑龙江省农垦总局建三江管理局八五九农场医院超声科,黑龙江哈尔滨150036 [3]中国医科大学附属第一医院心内科,辽宁沈阳110001

出　　处：《中国医学影像技术》2013年第1期42-45,共4页Chinese Journal of Medical Imaging Technology

基　　金：辽宁省自然科学基金(20102280)

摘　　要：目的探讨超声心动图预测心脏再同步化治疗(CRT)超反应的价值。方法对78例接受CRT术的慢性心力衰竭患者,分别于术前7天和术后1年行超声检查,测量左心室舒张末径(LVEDD)和射血分数(LVEF)、二尖瓣血流舒张早期(E)和舒张晚期速度(A),计算E/A和二尖瓣反流面积(MRA);以二维斑点追踪技术检测左心室收缩同步性(SI)。将CRT术后LVEF增加<5%定义为无反应组(CRT-NR),LVEF增加≥5%但LVEF<50%为CRT有反应组(CRT-R),LVEF≥50%为CRT超反应组(CRT-SR)。对3组间各参数进行统计学比较。结果术后12例为CRT-SR组(12/78,15.38%),其中扩张型心肌病(DCM)所占比例、左束支传导阻滞(LBBB)所占比例及其SI均大于CRT-NR组(19例,19/78,24.36%),MRA、E/A则小于CRT-NR组。CRT-SR组和CRT-R组(47例,47/78,60.26%)间DCM所占比例、LBBB所占比例、MRA和E/A差异有统计学意义。术前DCM所占比例、LBBB所占比例、MRA和E/A均与CRT超反应相关(r=0.51,0.40,-0.38,-0.32,P均<0.01)。结论CRT术前DCM合并LBBB、MRA较小和非限制型舒张功能减低患者术后更易出现超反应。Objective To investigate the role of echocardiography in prognosticating super-responders （SR） to cardiac resynchronization therapy （CRT）. Methods Seventy-eight heart failure patients underwent echocardiography examination 7 days before and 1 year after CRT. Left ventricular end-diastolic dimension （LVEDD）, ejection fraction （LVEF）, mitral regurgitation area （MRA）, and the ratio of mitral inflow early-diastolic to late-diastolic velocity （E/A） were measured. Meanwhile, LV synchrony index （SI） was detected using two-dimensional speckle tracking imaging. Patients with LVEF increase 〈5% were classified as non-responders （CRT-NR group）, LVEF increase ≥5% and LVEF 〈50% as responders （CRT-R group）, and those LVEF ≥50% were considered as super-responders （CRT-SR group） 1 year after CRT. Parameters among three groups were compared statistically. Results Twelve patients （12/78, 15.38%） were classified as CRT-SR. Compared with CRT-NR group （19/78, 24.36%）, there were more left bundle branch block （LBBB） and dilated cardiomyopathy （DCM） in CRT-SR group, longer SI and smaller MRA and E/A. The ratio of DCM, ratio of LBBB, MRA and E/A were statistical different between CRT-SR group and CRT-R group （47/78, 60.26%）. Before CRT, the ratio of DCM and LBBB, MRA and E/A were correlated with super-responders （r=0.51, 0.40, -0.38, -0.32, all P〈0.01）. Conclusion DCM patients with LBBB, smaller MRA and non-restrictive diastolic model tend to become super-responders after CRT.

关 键 词：超声心动描记术 再同步化治疗 超反应 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]