在心脏再同步治疗后,回声心脏学异步与长期存活的关系
John Gorcsan1, Olusegun Oyenuga, Phillip J Habib
1University of Pittsburgh, Scaife 564, 200 Lothrop St, Pittsburgh, PA 15213-2582, USA. gorcsanj@upmc.edu
Circulation
|October 27, 2010
概括
声心图异步预测心力衰竭患者接受心脏再同步治疗 (CRT) 的长期存活率. 缺乏异步,特别是较窄的QRS持续时间,表明CRT后的预后较差.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 心脏衰竭管理的管理
背景情况:
- 预测心脏再同步疗法 (CRT) 使用心声回声失同的反应仍然具有挑战性.
- 心力衰竭患者通常具有复杂的电气和机械失调,影响治疗疗效.
研究的目的:
- 测试该假设,即基线回声心脏学异步预测CRT患者的长期存活率.
- 确定与CRT后改善结果相关的特定心声回声失调指数.
主要方法:
- 在接受CRT的229名心力衰竭患者 (NYHA类III-IV,LVEF≤35%,QRS持续时间≥120毫秒) 的前性纵向研究中.
- 使用组织多普勒,12位标准偏差 (Yu指数),斑点跟踪辐射应变和脉冲多普勒室间机械延迟评估了基线异步.
- 主要结局是免于死亡,心脏移植或左心室辅助装置植入超过4年的时间.
主要成果:
- 在有数据的210名患者中,62人在4年内经历了不良事件 (47例死亡,9例移植,6例LVAD).
- 无事件生存与尤指数,斑点跟踪辐射应变和腹腔间机械延迟显著相关.
- 在对缺血源和QRS持续时间进行调整后,Yu指数和辐射菌株异步仍然是结果的独立预测因素.
结论:
- 缺少心声回声失调与CRT后不太有利的无事件生存率有关.
- 缺乏异步的QRS持续时间较窄的患者 (<150毫秒) 长期表现最差.
- 这些发现强化了回声心脏学异步在预测CRT反应和指导治疗中的关键作用.
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