Correlation between Echocardiographic Mechanical Synchrony Parameters and Efficiency of Cardiac Resynchronization Therapy

doi:10.12114/j.issn.1007-9572.2019.00.245

Abstract

Abstract: Background　Ventricular mechanical synchrony can be evaluated by methods such as echocardiography.A single-center study found that using echocardiography to assess cardiac mechanical synchrony could identify which patients could benefit from cardiac resynchronization therapy （CRT）．However，prospective，multicenter，non-randomized controlled studies have confirmed that cardiac mechanical synchrony parameters cannot be used to screen CRT patients and predict the reactivity.Objective　To explore the role of echocardiographic mechanical synchrony parameters to the clinical efficiency of CRT patients.Methods　We retrospectively studied 124 patients with chronic heart failure who underwent CRT from the Department of Cardiovascular of Peking University People's Hospital from June 2009 to June 2013.Based on the clinical effect and echocardiographic assessments in the six months follow-up after the treatment，we allocated them into non-responders group （34 patients），responders group （48 patients） and super-responders group （42 patients）．General data of the patients were collected，and mechanical synchrony parameters were evaluated by echocardiography before and after the treatment.Multivariate Logistic regression analysis was used to analyze the influencing factors of CRT non-responsers and super-responders.Results　There were no differences in QRS duration，inter-ventricular mechanical delay （IVMD），velocity time integral of aortic valve （VTIAV），and velocity time integral of mitral valve （VTIMV） among three groups in the six months after the treatment （P>0.05）．The differences in left ventricular ejection fraction （LVEF），diastolic filling time/RR interval （DFT/RR），EA peak overlap ratio，septum posterior wall mechanical delay （SPWMD），and left ventricular pre-ejection period （LVPEP）were significant among three groups in the six months after the treatment （P<0.05）．Multivariate Logistic analysis showed that there was a regression relationship between QRS duration prolong after CRT and non-response to CRT〔OR=4.383，95%CI（1.013，18.963）〕；DFT/RR≥55% 〔OR=3.609，95%CI（1.124，11.584）〕 and EA wave peak overlap ratio<10% 〔OR=5.267，95%CI（1.400，19.820）〕 were related to super-response to CRT （P<0.05）．Conclusion　Patients with chronic heart failure have different response to CRT.And 27.4% of patients have no response to CRT，and 33.9% of patients are classified as super-responders to CRT.QRS duration prolong after CRT is related to the non-response to CRT，and DFT/RR≥55% and EA wave peak overlap ratio<10% are related to super-response to CRT.

Key words: , Heart failure；Cardiac resynchronization therapy；Echocardiography；Treatment outcome；QRS duration；Diastolic filling time/RR interval；EA wave peak overlap ratio

摘要： 背景　心室机械同步性可以通过超声心动图等方法评价。单中心研究发现，超声心动图评价心脏机械同步性，能够鉴别哪些患者可以从心脏再同步化治疗（CRT）中获益。但是前瞻、多中心、非随机对照研究证实，心脏机械同步性指标不能用于筛选CRT患者和预测反应性。目的　探讨超声心动图机械同步性指标与CRT临床疗效的相关性。方法　选取2009年6月—2013年6月北京大学人民医院心脏中心行CRT的慢性心力衰竭患者124例，根据患者治疗后6个月随访时的临床效果和超声心动图结果分为无反应组34例、有反应组48例、超反应组42例。收集患者一般资料，治疗后采用超声心动图评价机械同步性指标。采用多因素Logistic回归分析CRT无反应及超反应影响因素。结果　3组患者治疗后6个月QRS波时限、心室间机械延迟（IVMD）、主动脉瓣血流速度时间积分（VTIAV）、左房室瓣血流速度时间积分（VTIMV）比较，差异均无统计学意义（P>0.05）；3组患者治疗后6个月左心室射血分数（LVEF）、心率校正左心室舒张充盈时间（DFT/RR）、EA峰重叠比例、室间隔后壁机械延迟（SPWMD）、左心室射血前时间（LVPEP）比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，CRT后QRS波时限延长与CRT无反应有回归关系〔OR=4.383，95%CI（1.013，18.963）〕，DFT/RR≥55%〔OR=3.609，95%CI（1.124，11.584）〕和EA峰重叠比例<10%〔OR=5.267，95%CI（1.400，19.820）〕与CRT超反应有回归关系（P<0.05）。结论　慢性心力衰竭患者对CRT反应性不同，27.4%的患者对CRT无反应，33.9%的患者对CRT超反应。CRT后QRS波时限延长与CRT无反应相关，DFT/RR≥55%和EA峰重叠比例<10%与CRT超反应相关。

关键词: 心力衰竭, 心脏再同步化治疗, 超声心动描记术, 治疗结果, QRS波时限, 心率校正左心室舒张充盈时间, EA峰重叠比例

WANG Jiayu,ZHANG Ping,LI Xuebin, et al. Correlation between Echocardiographic Mechanical Synchrony Parameters and Efficiency of Cardiac Resynchronization Therapy　[J]. Chinese General Practice, 2019, 22(23): 2805-2810. DOI: 10.12114/j.issn.1007-9572.2019.00.245.
王佳玉,张萍,李学斌等. 超声心动图机械同步性指标与心脏再同步化治疗临床疗效的相关性研究[J]. 中国全科医学, 2019, 22(23): 2805-2810. DOI: 10.12114/j.issn.1007-9572.2019.00.245.

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