如何在心脏再同步治疗候选人中使用心声回声学视觉诊断机械失调?
Pedro G Diogo1, Kenji Demesure1, Alexis Puvrez1,2
1Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium.
European heart journal. Imaging methods and practice
|January 9, 2026
概括
使用隔膜闪光和顶端摇摆对机械失同 (MechDys) 的视觉评估可以帮助识别可能受益于心脏再同步治疗 (CRT) 的心力衰竭患者. 本实用指南详细介绍了MechDys的识别,以提高CRT响应率.
科学领域:
- 心脏病学 心脏病学
- 心声回声图 (Echocardiography) 是一种心声回声图.
- 心脏衰竭管理的管理
背景情况:
- 心脏再同步治疗 (CRT) 对心力衰竭患者具有广泛的QRS综合体是有益的,但不响应率在20-45%之间.
- 机械失调 (MechDys),通过隔膜闪光 (SF) 和/或顶端摇摆 (ApR) 视觉识别,与CRT反应密切相关.
- 精确识别MechDys对于优化CRT患者选择至关重要.
研究的目的:
- 提供一个实用的,四步工作流程,用于使用心声回声学进行MechDys的视觉评估.
- 引导临床医生识别最有可能从CRT中受益的患者.
- 增强患者对CRT的选择,提高治疗响应率.
主要方法:
- 获取高质量的多视图回声心脏图像.
- 识别隔膜闪光 (SF) 作为早期向左隔膜运动,先于侧面壁收缩.
- 标识顶点摇摆 (ApR) 是双相顶点运动,反映了连续的隔膜和侧壁收缩.
主要成果:
- 通过存在SF或ApR来确认MechDys.
- 对MechDys的视觉评估可能会改善CRT的患者选择.
- 观测数据支持使用视觉MechDys评估进行中间CRT指示.
结论:
- 针对MechDys的实用视觉评估工作流可以帮助选择心力衰竭患者进行CRT.
- 通过MechDys评估改善患者选择可能会增加CRT反应率.
- 其他前性证据,例如来自AMEND-CRT试验,正在评估SFoAR评估在CRT决策中的临床实用性.
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