使用周长和纵向应变的心脏失同分析:对评估心脏重同步的含义
Robert H Helm1, Christophe Leclercq, Owen P Faris
1Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, 720 Rutland Ave, Baltimore, MD 21205, USA.
周围应变分析比纵向应变更好地预测心力衰竭中的心脏再同步治疗 (CRT) 反应. 这突出了纵向测量的局限性,并支持开发基于周长的方法,以改善患者选择.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 医疗成像医学成像
背景情况:
- QRS持续时间是心力衰竭中心脏再同步治疗 (CRT) 反应的标准但不完美的预测指标.
- 目前的心声回声学方法通常依赖于纵向应变 (epsilonll),但与周边应变 (epsiloncc) 相比,其有效性尚不清楚.
研究的目的:
- 为了比较纵向 (epsilonll) 和周边 (epsiloncc) 应变分析的能力,以评估机械失调并预测CRT反应.
- 评估不同节奏模式 (双心室与左心室) 对重同步指标的影响.
主要方法:
- 用3DMRI标记成像来计算心力衰竭和导电延迟的狗的左心室epsilonll和epsiloncc.
- 使用时间和区域应变差分析来评估异步.
- 通过双心室 (BiV) 或左心室 (LV) 节奏来实施CRT.
主要成果:
- 通过CRT,epsilonll和epsiloncc都得到了改善,但基于epsiloncc的指标与全球功能改善有更好的相关性.
- 纵向分析显示与BiV节奏,但不是LV节奏的重同步,与功能益处的相关性很差.
- 基于epsilonll的指数在抽缩期间显示出有限的重同步,与epsiloncc相比,其差异更高.
结论:
- 周围应变分析对异步更敏感,并且比纵向应变分析更好地预测CRT反应.
- 纵向应变测量有局限性,包括不同的时间配置和较低的动态范围,可能会影响CRT结果预测.
- 建议开发基于环形变形的非侵入性同步措施,以改善CRT患者的选择.
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