左心室整体及电极位置心肌纵向应变预测缺血性心力衰竭患者心脏再同步化治疗的长期疗效  

Evaluation on left ventricle global and regional longitudinal strain in predicting long-term response to cardiac resynchronization therapy in patients with ischemic heart failure

作　　者：马春燕[1] 刘爽[1] 杨军[1] 张妍[1] 张立敏[1] 李楠[1] 于波[2] 

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]中国医科大学附属第一医院心血管心内科,辽宁沈阳110001

出　　处：《中国医学影像技术》2013年第12期1965-1968,共4页Chinese Journal of Medical Imaging Technology

基　　金：辽宁省科技厅科学计划项目(2011225020)

摘　　要：目的采用二维斑点追踪技术(STE)检测缺血性心力衰竭(HF)患者左心室收缩同步性、整体纵向应变(GLS)及左心室电极植入部位心肌纵向应变(RLS),探讨其在预测CRT长期疗效中的作用。方法 42例缺血性HF接受CRT,对其在术前1周和术后1年行STE检查,测量GLS及RLS,同时测量左心室18节段达峰值纵向应变时间标准差(T-LS SD)及前间壁和后壁达峰值径向应变的时间差(T-RSDif)作为收缩同步性指数,以术后1年左心室收缩末容积(LVESV)减小≥15%为CRT有效。结果 29例CRT治疗有效(CRT-R组),13例治疗无效(CRT-NR组)。术前CRT-R组RLS、GLS、T-LSSD和T-RSDif大于CRT-NR组(P<0.001)。术前以RLS-11.5%预测CRT疗效的敏感度和特异度分别为80.00%和77.90%(AUC=0.84,P<0.001)。结论通过STE检测左心室收缩同步性、GLS和电极植入部位RLS可预测缺血性心力衰竭患者的CRT长期疗效。Objective To investigate the role of left ventricular （LV） systolic synchrony and longitudinal strain （LS） obtained with two-dimensional speckle tracking echocardiography （STE） in predicting long-term response to cardiac resynchronization therapy （CRT） in patients with ischemic heart failure （HF）. Methods STE was performed in 42 patients with HF 1 week before and 1 year after CRT. Global LS （GLS）, regional LS （RLS） and the LV synchrony index （SI）, defined as SD in timing to peak longitudinal strain among 18 segments （T-LSSD）, and the difference in timing to peak radial strain between LV anterior septal and posterior wall （T-RSDif） were calculated. Decrease ≥15% of LV end-systolic volume （LVESV） one year after CRT was defined as response to CRT. Results Twenty-nine patients responded to CRT （CRT-R group）, while 13 patients did not respond to CRT （CRT-NR group）. Pre-CRT RLS, GLS, T-LSSD and T-RSDif were higher in CRT-R group compared with those in CRT-NR group （P〈0.001）. Taking RLS of －11.5% as standard for response to CRT, the sensitivity was 80.00%, the specificity was 77.90% （AUC=0.84, P〈0.001）. Conclusion Evaluation on systolic synchrony of LV, GLS and RLS with STE can predict long-term response to CRT in patients with ischemic HF.

关 键 词：心力衰竭 缺血性 心室功能 左 收缩同步性 心脏再同步化治疗 

分 类 号：R541.61[医药卫生—心血管疾病] R445.1[医药卫生—内科学]