基于磁共振的室间隔应变对不符合真性左束支阻滞患者心脏再同步治疗反应的预测价值  

The predictive value of cardiac magnetic resonance-based septal strain for identifying cardiac resynchronization therapy responders among patients without true left bundle branch block

作　　者：陈中丽 马璇 徐楠 吴斯谨 高远 陈峰 李崇强 戴研 华伟 赵世华 陈柯萍 Chen Zhongli;Ma Xuan;Xu Nan;Wu Sijin;Gao Yuan;Chen Feng;Li Chongqiang;Dai Yan;Hua Wei;Zhao Shihua;Chen Keping(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Department of Magnetic Resonance Imaging,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Department of Echocardiography,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Catheterization Laboratory,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院心律失常中心,北京100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院磁共振影像科,北京100037 [3]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院超声影像中心,北京100037 [4]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验、阜外医院介入导管室,北京100037

出　　处：《中华心律失常学杂志》2023年第5期397-405,共9页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81870260,81930044)。

摘　　要：目的评估心脏再同步治疗(CRT)术前基于心脏磁共振特征追踪技术(CMR-FT)的左心室应变特征对于患者CRT超声反应的预测价值。方法本研究为回顾性研究,纳入2017年1月至2019年12月在中国医学科学院阜外医院接受双心室起搏CRT,术前心电图为QRS时限(QRSd)>120 ms但不符合真性左束支阻滞(LBBB)的心力衰竭患者,所有患者CRT植入术前3个月内均接受心脏磁共振(CMR)平扫检查。运用CMR-FT技术评估左心室整体、侧壁及室间隔(Sep)纵向(LS)、周向(CS)及径向(RS)应变。CRT反应定义为术后6个月超声心动图评估的左心室射血分数(LVEF)绝对值增加至少超过5%。结果研究纳入73例患者,年龄(55.6±11.6)岁,其中男占79.45%(58/73)。60.3%(44/73)患者有反应,仅8.2%(6/73)患者超反应。相对于无反应患者(29例),有反应患者(44例)Sep-LS[-3.98%(-6.05%~-1.44%)对-7.08%(-8.75%~-3.14%),P=0.038],Sep-CS[-2.75%(-4.60%~-0.98%)对-5.71%(-7.12%~-4.09%),P<0.001],Sep-RS[4.17%(1.77%~6.68%)对7.55%(5.72%~9.77%),P<0.001]均显著降低。其中Sep-RS及Sep-CS与LVEF改善程度显著相关(Sep-RS:r=-0.42;Sep-CS:r=0.43,P<0.001)。单因素Logistic回归模型结果表明基线QRSd、基线LVFE、QRS波缩窄程度、心输出量、Sep-CS与Sep-RS是CRT反应的预测因素,在矫正其他有意义因素后Sep-CS仍与CRT反应独立相关[OR=1.201,95%CI 1.010~1.428,P=0.039]。Sep-CS及Sep-RS截断值分别为-4.72%及5.71%时,预测CRT反应的受试者工作特征(ROC)曲线下面积分别为0.756及0.752。结论不符合真性LBBB的心力衰竭患者中,基于CMR-FT评估的Sep周向及径向应变的减低与CRT反应相关,其或可作为新型影像学标志物为该类患者的CRT获益评估提供较好的预测价值。ObjectiveTo evaluate the clinical value of cardiovascular magnetic resonance-feature tracking technique(CMR-FT)-based left ventricle strain for predicting echocardiographic response after cardiac resynchronization therapy(CRT).MethodsThis study retrospectively enrolled heart failure patients who underwent biventricular pacing CRT between January 2017 and December 2019,with QRS duration(QRSd)>120 ms but whose electrocardiogram morphology did not meet the true left bundle branch block(LBBB)criteria.All patients underwent plain cardiovascular magnetic resonance(CMR)scan within 3 months prior to the procedure.CMR-FT was used to quantify the left ventricle(LV)global,lateral and septal(Sep)strain in longitudinal(LS),circumferential(CS)and radial(RS)dimensions.CRT response was defined as a≥5%absolute increase in left ventricular ejection fraction(LVEF)evaluated by echocardiography 6 months after the procedure.ResultsSeventy-three patients were included[age(55.6±11.6)years old,male 79.45%(58/73)],among whom 60.3%(44/73)were CRT responders,and only 8.2%(6/73)were super-responders.Compared with non-responders,the responders had significantly impaired Sep-LS[-3.98%(-6.05%--1.44%)vs.-7.08%(-8.75%--3.14%),P=0.038],Sep-CS[-2.75%(-4.60%--0.98%)vs.-5.71%(-7.12%--4.09%),P<0.001]and Sep-RS[4.17%(1.77%-6.68%)vs.7.55%(5.72%-9.77%),P<0.001].Sep-RS and Sep-CS significantly correlated with LVEF improvement(Sep-RS:r=-0.42,P<0.001;Sep-CS:r=0.43,P<0.001).Univariate logistic regression indicated that baseline QRSd,LVEF,QRSd reduction,cardiac output,Sep-CS and Sep-RS were predictors of CRT response.After adjusting other significant factors,Sep-CS was also independently associated with CRT response[OR=1.20195%CI 1.010-1.428,P=0.039].With cut-off values of-4.72%and 5.71%respectively,Sep-CS and Sep-RS yielded area under the receiver operating characteristic curve of 0.756 and 0.752 respectively for predicting CRT response.ConclusionIn heart failure patients without true LBBB,CMR-FT-evaluated impaired septal circumferential and radial strain

关 键 词：室间隔 心脏再同步治疗 反应性 应变 心脏磁共振特征追踪技术 

分 类 号：R654.2[医药卫生—外科学]