右室长轴应变对心脏再同步化治疗效果的预测价值  

Predictive value of right ventricular systoliclongitudinal strainare on effect of reverse remodeling after cardiac resynchronization therapy

作　　者：吕文青[1] 智光[1] 王晶[1] 周肖[1] 刘峻松[1] 

机构地区：[1]解放军总医院心血管内科,北京100853

出　　处：《中国医药导报》2016年第8期64-67,共4页China Medical Herald

摘　　要：目的评价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2010年1月～2014年12月因心功能不全在解放军总医院植入CRT的患者65例。收集患者术前和术后6个月的临床资料和超声心动图指标，反映右室功能的指标包括右室收缩期长轴峰值应变（RVSLS）、右室面积变化分数（RVFAC）、三尖瓣瓣环收缩期位移（TAPSE）。按照CRT的超声反应将患者分为CRT治疗反应组和CRT治疗无反应组，比较两组的临床资料，分析患者右室收缩功能与CRT治疗效果的相关性，通过受试者工作特征曲线（ROC）分析得出指标的界值、灵敏度和特异度。结果65例患者中最终纳人60例，其中CRT治疗反应组38例（63％），治疗无反应组22例（37％）。RVSLS、RVFAC、TAPSE与CRT治疗效果有关（P〈0．01）。多变量Logistic回归模型及ROC结果显示：RVSLS可作为最有效预测指标（OR：3．55，95％CI：2．34～5．47，P〈0．01），界值为RVSLS〉17％，灵敏度为78．8％．特异度为76．3％。结论右室收缩功能可作为CRT效果的预测因子。Objective To evaluate the predictive value of right ventricular systoliclongitudinal strainare on effect of re- verse remodeling after cardiac resynchronization therapy （CRT）. Methods From January 2010 to December 2014, in Chinese PLA General Hospital, 65 heart failure patients with CRT were selected. Echocardiographic and clinical data before implantation and 6 months after implantation were collected, reflecting right ventricular function index including RVSLS, RVFAC, TAPSE. Patients were divided into CRT response group and CRT non-response group according to e- chocardiographic response, the clinical data of two groups were compared, the correlation between right ventricular contractility and CRT effect, cut-off level, sensitivity and specificity were got by ROC. Results In 65 patients, 60 cases were intaken, 38 cases （63%） were in CRT response group, 22 cases （37%） were in CRT non-response group. RVSLS, RVFAC, TAPSE had correlation with CRT effect （P 〈 0.01）. Multiple Logistic analysis and ROC result identified that RVSLS was as the independent predictor of reverse remodeling （OR = 3.55, 95%CI： 2.34-5.47, P 〈 0.01）, cut off val- ues was RVSLS〉17%, sensitivity was 78.8%, and specificity was 76.3%. Conclusion Right ventricular systolic function can be as predictor of CRT effect.

关 键 词：心脏再同步化治疗 心力衰竭 超声心动图 心肌 

分 类 号：R542.22[医药卫生—心血管疾病]