超声心动图预测慢性充血性心力衰竭患者心脏再同步化治疗急性反应  

Echocardiography in prognosticating acute-response to cardiac resynchronization therapy in chronic heart failure patients

作　　者：关正宇[1] 马春燕[1] 王永槐[1] 张妍[1] 刘爽[1] 宋晶京 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]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》2015年第5期737-741,共5页Chinese Journal of Medical Imaging Technology

基　　金：沈阳市科学技术项目(F13-221-9-60)

摘　　要：目的探讨超声心动图预测慢性充血性心力衰竭(CHF)患者心脏再同步化治疗(CRT)急性反应的价值。方法选取接受CRT的CHF患者33例,分别在CRT开启(ON)和关闭(OFF)状态下进行超声心动图检查,测量左心房最大前后径(LAD)、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、房室同步性(A-V-D)、心室间同步性(V-V-D)。采用组织多普勒技术(TDI)测量左心室收缩(Vs-T-SD)和舒张同步性(Ve-T-SD);实时三维超声心动图(RT-3DE)检测左心室收缩同步性(T16-SD%)。将CRT-ON时,LVEF增加≥5%设为有反应(CRT-R)组,<5%为无反应(CRT-NR)组。对以上数据进行统计学分析。结果25例患者(25/33,75.76%)为CRT-R组,8例(8/33,24.24%)为CRT-NR组。CRT-R组,CRT-ON时QRSd、LVEDD、LVESD、LAD、LVEDV、LVESV、V-V-D和T16-SD%较CRT-OFF时减小,LVSV和LVEF增加(P均<0.05);CRT-NR组,CRT-ON时LVEDD、LVESD和LAD较CRT-OFF时减小,LVEF增加(P均<0.05)。术前CRT-R组LAD和LVEDD小于CRT-NR组,而左束支传导阻滞和非缺血性心肌病患者的比例、V-V-D大于CRT-NR组(P均<0.05)。V-V-D为44ms时,曲线下面积为0.747,预测CRT急性反应有效的敏感度及特异度分别为60.0%和87.5%(P<0.05)。结论 LAD和LVEDD较小、室间同步性较差且合并左束支传导阻滞的非缺血性心肌病的CHF患者更可能CRT急性反应有效,V-V-D可准确预测CRT急性反应。Objective To investigate the value of echocardiography in prognosticating acute-response to cardiac resyn- chronization therapy （CRT） in chronic heart failure （CHF） patients. Methods Thirty-three CHF patients underwent echocardiography examination when CRT-ON and CRT-OFF, respectively. Left atrial dimension （LAD）, left ventricular end diastolic dimension （LVEDD）, ejection fraction （LVEF）, atrio-ventricular dyssynchrony （A-V-D）, interventricular dyssynchrony （V-V-D） were measured. LV systolic and diastolic synchrony （Vs-T-SD and Ve-T-SD） were detected by tissue Doppler imaging. Meanwhile, LV dyssynchrony （T16-SD%） was detected by real-time three-dimensional echocardiography （RT-3DE）. Patients were divided into CRT responders （CRT-R） group and CRT no-responders （CRT-NR） group accord- ing to a increase in LVEF≥5 % or not on CRT-ON. The statistical analysis was performed. Results All of 25 patients （25/33, 75.76%） were enrolled in CRT-R group, and 8 （8/33, 24. 24%） were in CRT-NR group. Compared with CRT- OFF, the patients showed significant decrease in QRSd, LVEDD, LVESD, LAD, LVEDV, LVESV, V-V-D 和 T16- SDM, increase in LVSV and LVEF when CRT-ON in CRT-R group （all P%0.05）, decrease in LVEDD, LVESD and LAD, increase in LVEF when CRT-ON in CRT-NR group （all P^0.05）. LAD and LVEDD was lower, and the propor- tion of left bundle branch block （LBBB） and non-ischemic heart disease （NICM） was higher in CRT-R group than those in CRT-NR group before operation （all P〈0.05）. The sensitivity and specificity of V-V-D in predicting acute-response of CRT were 60.0% and 87.5% （P〈0.05）, with cut-off value of 44 ms and area under curve of 0. 747. Conclusion CHF patients combined with NICM and LBBB has smaller LAD and LVEDD, and worse interventricular dyssynchrony tends to become acute-responders after CRT. V-V-D can accurately predict acute-response of CRT.

关 键 词：超声心动描记术 心脏再同步化治疗 急性反应 

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