对比三维斑点追踪技术和二维斑点追踪技术评价正常人左心室心肌应变

目的 应用二维斑点追踪成像（2D-STE）与三维斑点追踪成像（3D-STE）技术评估正常人左心室心肌应变。方法 对34名正常人进行左心室心肌二维、三维图像采集,通过二维图像获取左心室心肌收缩末期17节段纵向应变（LS）、18节段环向应变（CS）及径向应变均（RS）,通过三维图像获得面积应变（AS）、LS、RS及CS。结果 3D-STE与2D-STE的LS和CS均自基底段至心尖段逐渐增大,RS均逐渐减。与2D-STE相比,3D-STE测得的LS较小,CS较大（P均<0.05）。3D-STE所测的AS与LVEF相关性最强（r=-0.720,P<0.05）。3D-STE获取图像及脱机分析时间明显少于2D-STE（P均<0.05）。结论 3D-STE是更全面、省时、高效的应变测量方法。作为3D-STE的新型应变参数,AS能更全面地反映左心室收缩功能。     

三维斑点追踪成像评价亚临床甲状腺功能减退患者左心室收缩功能

目的 评价三维斑点追踪成像(3D-STE)技术对亚临床甲状腺功能减退(SCH)患者左心室心肌功能减低的预测价值。方法 对32例SCH患者(SCH组)和30名健康志愿者(对照组)行3D-STE检查,获得左心室收缩期整体面积应变(GAS)、整体纵向应变(GLS)和整体环向应变(GCS)。比较对照组和SCH组治疗前后左心室三维应变参数差异,以左心室射血分数<65%为诊断左心室收缩功能减低金标准,采用ROC曲线评价左心室三维应变参数诊断SCH左心室收缩功能减低的效能。结果 SCH组治疗前后GAS、GLS和GCS绝对值均低于对照组(P均<0.05),治疗后GAS、GLS和GCS绝对值均高于治疗前(P均<0.05)。ROC曲线显示GAS、GLS和GCS的AUC分别为0.805、0.723和0.614,分别以-40.5%、-29.3%和-32.6%作为GAS、GLS和GCS诊断左心室功能减低界值,其敏感度分别为85.7%、77.8%和71.1%,特异度分别为72.2%、71.3%和60.1%。结论 3D-STE中GAS诊断SCH患者左心室收缩功能减低效能较高,具有一定的临床预测价值。     

二维斑点追踪超声心动图评估冠状动脉病变对收缩早期左心室心肌运动的影响

目的观察采用二维斑点追踪超声心动图(2D-STE)评估冠状动脉病变对收缩早期左心室心肌运动影响的可行性。方法将179例接受冠状动脉造影检查的可疑冠心病患者的左心室心肌节段按供血冠状动脉狭窄程度分为对照组(无狭窄)、轻度组(狭窄程度≤50%)、中度组(50%<狭窄程度<75%)和重度组(狭窄程度≥75%)。采用2D-STE分析各组左心室心肌节段纵向预拉伸峰值应变(LPSS)和圆周预拉伸峰值应变(CPSS)的差异。结果左心室各层心肌LPSS和CPSS峰值于收缩早期出现,轻度组均最高(P均<0.05),中度组最低(P均<0.05);冠状动脉轻度狭窄时收缩早期左心室心肌拉伸运动加强,随着冠状动脉病变加重而逐渐减弱。结论2D-STE可无创评估冠状动脉病变对收缩早期左心室心肌运动的影响。     

Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography

Background  

The aim of this study was to compare left atrial (LA) longutidinal myocardial function in obstructive sleep apnea (OSA) patients with healthy individuals using two-dimensional speckle-tracking echocardiography method (2D-STE).     

Are biventricular systolic functions impaired in patient with coronoray slow flow? A prospective study with three dimensional speckle tracking

The newly developed three dimensional speckle-tracking echocardiography (3D-STE) technology provides quick and comprehensive quantitative assessment of biventricular myocardial dynamics. The impact of coronary slow flow phenomenon (CSFP) on biventricular functions has not been comprehensively evaluated using this new technology. Therefore, the aim of this study was to evaluate the effects of CSFP on biventricular systolic functions using 3D-STE. Forty patients with CSFP and otherwise normal coronary arteries (NCAs) and 40 age- and sex-matched controls with normal coronary angiograms (CAGs) were prospectively enrolled. Biventricular systolic function was evaluated by 3D-STE. Left ventricular (LV) global longitudinal, circumferential and radial strains, ejection fraction (EF) were significantly lower and LV end-systolic volume (ESV) was significantly higher in the CSFP group compared to the control group. There were no significant differences in LV mass, LV end-diastolic volume (EDV) or LV stroke volume (SV). Additionally, Right ventricular (RV) free wall, septal wall and global longitudinal strains, and RV EF were significantly lower in the CSFP group, but there were no significant differences in RV EDV, ESV and RV SV. The present study demonstrated that CSFP has a notable negative effect on not only 3D strain parameters but also biventricular EF. There was a strong correlation between the strain parameters of the affected vessel’s myocardial area and the TIMI frame count of same vessel.     

超声心动图观察经皮冠状动脉介入术后心肌缺血再灌注损伤

目的应用常规超声心动图及二维斑点追踪(2D-STE)技术对经皮冠状动脉介入(PCI)术后心肌缺血再灌注损伤(MIRI)进行观察和评价。方法收集32例拟接受急诊PCI术的心肌梗死患者,其中15例血管开通后发生临床MIRI(MIRI组),17例未发生MIRI(对照组)。采用常规超声心动图及2D-STE,于术前8 h内及术后2 h内对左心结构、舒张及收缩功能和长轴应变(GLS)进行评价,对比组间及组内术前、术后各超声指标。结果PCI术前、术后,2组左心内径及室壁厚度差异均无统计学意义(P均>0.05)。术后MIRI组E峰较术前显著降低(P=0.032),E/A显著低于术前(P=0.021),二尖瓣瓣环舒张早期运动速度e显著低于术前(P=0.018),E/e高于术前(P=0.047);对照组舒张功能无显著变化(P>0.05)。MIRI组术后射血分数(ET)无明显变化,GLS显著减低(P<0.05),对照组术后EF及GLS显著升高。结论PCI术后发生临床MIRI者舒张功能及GLS减低,联合常规超声心动图及2D-STE可对PCI术后MIRI进行评价。     

Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease

2D-STE (two-dimensional speckle tracking echocardiography) is a novel echocardiographic modality that enables angle-independent assessment of myocardial deformation indices. In the present study, we tested whether peak systolic epsilon(parallel) (longitudinal strain) values measured by 2D-STE could identify areas of MI (myocardial infarction) as determined by CE MRI (contrast-enhanced magnetic resonance imaging). Conventional echocardiographic apical long-axis recordings were performed in 38 patients, 9 months after a first MI. Peak systolic epsilon(parallel) measured by 2D-STE in 16 left ventricle segments was compared with segmental infarct mass and transmurality assessed by CE MRI. Segmental values were averaged to global and territorial values for assessment of global function and myocardial function in the coronary distribution areas. CE MRI identified transmural infarction in 27 patients, and a mean infarct size of 36+/-25 g. Peak systolic epsilon( parallel) correlated with the infarct mass at the global level (r=0.84, P<0.001). A strain value of -15% identified infarction with 83% sensitivity and 93% specificity at the global level and 76% and 95% at the territorial level, and a strain value of -13% identified transmural infarction with 80% sensitivity and 83% specificity at the segmental level. Global infarct mass correlates with the wall motion score index (r=0.70, P<0.001), and left ventricular ejection fraction measured by MRI or echocardiography (r=-0.71 and -0.58, both P<0.001). In chronic infarction, peak systolic epsilon(parallel) measured by 2D-STE correlates with the infarct mass assessed by CE MRI at a global level, and separates infarcted from non-infarcted tissue. Global strain is an excellent predictor of myocardial infarct size in chronic ischaemic heart disease.     

三维面积应变评价高血压患者左心室心肌收缩功能早期变化

目的 应用三维斑点追踪成像（3D-STE）技术评价原发性高血压患者早期左心室心肌收缩功能改变情况。方法 对40例未经药物治疗的原发性高血压患者（高血压组）及40名健康志愿者（对照组）行常规二维超声心动图和3D-STE,测量并比较两组常规超声心动图指标包括舒张末期室间隔厚度（IVSTd）、舒张末期左心室后壁厚度（LVPWTd）、左心室舒张末期内径（LVEDd）、相对室壁厚度（RWT）、二维左心室心肌质量指数（2D-LVMi）、二维左心室射血分数（2D-LVEF）、舒张末期左心室容积（EDV）、收缩末期左心室容积（ESV）,以及3D-STE指标包括左心室三维射血分数（3D-LVEF）、左心室球形指数（SPI）、三维左心室心肌质量指数（3D-LVMi）及左心室整体面积应变（GAS）差异;采用Pearson相关分析检验GAS与各指标间相关性。结果 两组患者IVSTd、LVPWTd、LVEDd、RWT、2D-LVMi、2D-LVEF、EDV、ESV、3D-LVEF和SPI差异均无统计学差异（P均>0.05）;高血压组3D-LVMi高于对照组[(104.20±7.94) vs (92.85±6.92),P<0.05),GAS低于对照组[(-25.53±3.79) vs (-31.43±3.13),P<0.05]。GAS与3D-EF呈负相关（r=-0.78,P<0.05）,与3D-LVMi、收缩压及舒张压呈正相关（r=0.81、0.60、0.50,P<0.05）。结论 原发性高血压患者早期左心室构型未发生明显变化时,左心室心肌收缩功能已经减低,可通过3D-STE中GAS进行评价。     

Evaluation of left ventricular myocardial mechanics by three-dimensional speckle tracking echocardiography in the patients with different graded coronary artery stenosis

To investigate the relationship between left ventricular (LV) myocardial mechanics evaluated by three-dimensional speckle tracking echocardiography (3D-STE) and degree of coronary artery stenosis in patients with coronary artery disease (CAD). Ninety-seven suspected CAD patients without LV regional wall motion abnormality (RWMA) observed visually form traditional echocardiography were divided into four groups according to coronary artery angiography (CAG): 23 patients in slight stenosis group [stenosis rate (SR)?≤25%], 26 patients in mild stenosis group (25<?SR?≤50%), 28 patients in moderate stenosis group (50<?SR?≤75%), and 20 patients in severe stenosis group (SR?>75%). Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), area strain (AS) and three dimensional strain (3D-Strain) were obtained. The parameters from 3D-STE were compared between different groups and then the diagnostic value of global strains indicating different graded coronary artery stenosis was analyzed by the receiver operating characteristic curve. (1) There were significant difference in GLS, GCS, GRS, GAS and 3D-Strain between the severe stenosis group and any other group while all 3D-STE parameters except GCS in the moderate stenosis group were remarkably different from those respectively in mild group. (2) Receiver operator characteristic curve (ROC) analysis showed that the area under the curve of GLS, GRS, GCS, GAS, 3D-Strain were 0.899, 0.873, 0.723, 0.856 and 0.863 respectively for the identification of stenosis rate?>50%, and 0.896, 0.866, 0.797, 0.909 and 0.899 respectively for the identification of severe stenosis. GAS less than ?29.13% allowed a sensitivity of 95% and a specificity of 71.4%, while 3D strain less than 41.35% allowed a sensitivity of 90% and a specificity of 80.5% for evaluating serve coronary artery stenosis. The myocardial mechanics from 3D-STE in the CAD patients were characteristic. It could be expected to identify serve coronary stenosis with a good sensitivity and an acceptable specificity by using GAS or 3D-strain especially in the suspected CAD patients without RWMA on conventional echocardiography.     

斑点追踪超声心动图评估冠状动脉杂交血运重建术短期疗效

目的应用二维斑点追踪超声心动图(2D-STE)定量评价冠心病多支病变患者行冠状动脉杂交血运重建术(HCR)术前、术后左室心肌功能变化,探讨HCR短期治疗效果。方法选取经冠状动脉造影诊断为多支病变且成功行HCR术的冠心病患者30例,另外选取20例健康志愿者作为对照组,测量常规及2D-STE超声心动图参数,左室整体长轴应变改善的影响因素采用线性回归分析。结果(1)与对照组相比,HCR组术前左室射血分数、左室长轴应变及圆周应变均减低(P<0.05)。(2)HCR术后8周,各常规超声心动图参数改变较术前无统计学意义(P>0.05),左室长轴应变及圆周应变较术前有所改善,但仍低于对照组,差异有统计学意义(P<0.05)。(3)多元线性回归分析显示SYNTAX评分、术前左室整体长轴应变是术后左室整体长轴应变改善的独立预测因子。结论冠心病冠状动脉多支病变患者左室心肌功能减低,HCR术后8周左室心肌功能明显改善,HCR短期疗效显著。     

Histologic and Hemodynamic Correlates of Right Ventricular Function in a Pressure Overload Model: a Study Using Three-Dimensional Speckle Tracking Echocardiography

The aim of our study was to assess the characterization of right ventricular (RV) deformation using three-dimensional (3D) speckle tracking echocardiography (STE) and association of 3D-STE indices with histologic and hemodynamic parameters in a chronic RV pressure overload animal model. Pulmonary artery banding (PAB) was used to induce RV pressure overload in seven beagles. 3D-STE, histologic and hemodynamic measurements were performed in PAB and sham-operated beagles 3?mo after PAB. RV longitudinal, radial and circumferential strain was measured from 3D-STE. Three mo after PAB, RV longitudinal strain was decreased; whereas radial and circumferential strain remained unchanged in PAB group. RV longitudinal strain was associated with interstitial fibrosis (r?=??0.733) in the endocardial layer of the RV free wall. RV circumferential strain was related to dp/dt_max (r?=?0.718). The significant correlations of RV 3D-STE indices with histologic and hemodynamic parameters indicate that 3D-STE may be a valuable tool for assessment of ventricular function in RV pressure overload.     

Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”?

With the introduction of high-sensitivity troponin (hsTNI) assays, the clinical significance unstable angina (UA) has become uncertain. We hypothesized that impaired left ventricular (LV) two-dimensional speckle-tracking echocardiography (2D-STE)-derived peak global longitudinal strain (GLS) was able to exclude the presence of significant coronary artery disease (CAD) in UA patients without prior cardiovascular (CV) events and with a normal LV ejection fraction (LVEF). From a cohort of 200 patients admitted with UA, we selected 61 patients without prior CV events and with a normal LVEF; of these, 48 (79%) underwent invasive coronary angiography (ICA) and 24 (39%) had at least?≥?1 significant stenosis. 2D-STE LV GLS analysis was performed offline using a dedicated automated software program. The mean patient age was 61?±?12 years and 66% were male. Among the 48 patients selected to undergo ICA, those without significant CAD had a better 2D-STE GLS (??19.4 vs. ??15.9%, P?<?0.001). A cutoff of ??17.5% had a sensitivity of 87% and a specificity of 82% for differentiating UA patients without significant stenosis (AUC 0.86, P?<?0.001). Patients who did not undergo ICA had a better GLS (??20.2 vs. ??17.7%, P?=?0.017). 2D-STE GLS had a significantly better discriminative power compared with LVEF (P?<?0.001) and the GRACE score (P?<?0.001) for identifying patients with significant CAD. Impaired values of 2D-STE LV GLS were significantly associated with the presence of CAD in hsTnI-negative UA patients and demonstrated better discriminative power than LVEF and the GRACE score.     

应用三维斑点追踪技术评价2型糖尿病患者左心室收缩功能

目的 应用三维斑点追踪技术(3D-STE)检测2型糖尿病(T2DM)患者左心室收缩功能。 方法 收集T2DM患者55例,分为单纯糖尿病组31例和糖尿病合并微血管病变组24例;另选择健康人31名作为对照组。常规采集各切面图像和左心室全容积图像,将全容积图像输入TomTec 4D LV analysis软件,计算16节段心肌三维应变(3DS)、纵向应变(LS)、圆周应变(CS)值,并与左心室射血分数(LVEF)行相关性分析。 结果 与对照组比较,单纯糖尿病组和糖尿病合并微血管病变组中间部和心尖部的前间隔、侧壁,基底部和中间部后壁,心尖部下壁的3DS均显著减低(P均<0.05);中间部前间隔、前壁、后壁,心尖部后间隔 LS均减低(P均<0.05);基底部、中间部及心尖部侧壁,基底部和中间部后壁CS明显减低(P均<0.05);3DS与LVEF呈正相关(r=0.75,P<0.01)。 结论 3D-STE对评价糖尿病左心室动力学具有较高的应用价值;3DS可较CS、LS更全面、客观地评价糖尿病心肌病左心室心肌收缩功能受损情况。     

三维斑点追踪技术评价2型糖尿病合并非酒精性脂肪性肝病患者左心室功能

目的 探讨三维斑点追踪（3D-STE）技术评估2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者左心室功能的可行性。方法 对30例T2DM不合并NAFLD（A组）、32例T2DM合并轻度NAFLD（B组）及35例T2DM合并中重度NAFLD患者（C组）行3D-STE检查,检测常规参数,包括二尖瓣口舒张早期与晚期峰值血流速度比值（E/A）、舒张末期室间隔厚度（IVSTd）、左心室下侧壁厚度（PWTd）及舒张末期左心室内径（LVDd）、收缩末期左心室内径（LVDs）,左心室功能参数包括收缩末期左心房容积（LAV）、左心室质量（LVM）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室质量指数（LVMI）、左心室射血分数（LVEF）,以及3D-STE应变参数左心室整体纵向应变（GLS）、整体面积应变（GAS）、整体径向应变（GRS）和整体圆周应变（GCS）。以Pearson线性相关分析3D-STE参数与糖化血红蛋白（HbA1c）、体质量指数（BMI）的相关性。结果 3组E/A、IVSTd、PWTd、LVDd、LVDs、LVMI、LVEF、LVEDV及LVESV差异均无统计学意义（P均>0.05）,A、B组GRS、GCS、GLS、GAS均较C组增加（P均<0.05）。GLS、GRS、GCS、GAS与HbA1c均呈负相关（r=-0.540、-0.476、-0.489、-0.623,P=0.040、0.032、0.037、0.020）,与BMI均无相关性（P均>0.05）。结论 3D-STE可用于评价T2DM合并NAFLD患者左心室功能。     

三维斑点追踪技术可评价乳腺癌患者蒽环类药物治疗前后的心室功能改变

目的探讨三维斑点追踪技术（3D-STE）评价乳腺癌患者蒽环类药物治疗前后心室功能改变。方法应用常规超声心动图、二维斑点追踪技术（2D-STE）、3D-STE分别在蒽环类药物化疗前24 h、化疗第2周期及化疗第4周期结束24 h内进行左心室功能检测,对各参数在这3个时间点进行纵向对比,分析其与蒽环类药物累积剂量的相关性,以及对检测蒽环类药物心脏毒性所致心脏功能早期损害的敏感性。结果3D-STE的左室整体面积应变（3D-GAS）、整体长轴应变（3D-GLS）在化疗第2周期与化疗第4周期结束24 h内均低于化疗前24 h（P<0.05）;左室整体圆周应变（3D-GCS）在化疗第4周期结束24 h内低于化疗前24 h（P<0.05）;而左室整体径向应变（3D-GRS）于整个化疗过程中无明显改变（P>0.05）;在检测左心室功能早期损害方面,3D-GAS的敏感性为81.23%,特异性为81.98%;3D-GLS的敏感性为62.15%,特异性为65.02%;3D-GCS的敏感性为66.09%,特异性为55.08%;3D-GAS、3D-GLS、3D-GCS与蒽环类药物累积剂量成负相关（P<0.05）。结论3D-STE评价乳腺癌患者蒽环类药物治疗前后心室功能改变值得在临床影像学诊断中推广使用,是监测蒽环类药物所致心脏功能损害的一种敏感、可靠的影像学手段。      

Multilayer longitudinal strain at rest may help to predict significant stenosis of the left anterior descending coronary artery in patients with suspected non-ST-elevation acute coronary syndrome

Two-dimensional speckle tracking echocardiography (2D-STE) multilayer analysis of myocardial deformation is a non-invasive method that enables discrimination of transmural differences owing to myocardial ischemia or necrosis. We wished to ascertain if multilayer longitudinal strains at rest are associated with significant (≥70?%) stenosis of the left anterior descending coronary artery (LAD) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Our cohort comprised 113 consecutive patients with suspected NSTE-ACS and preserved ejection fraction (EF). Using coronary angiography, we diagnosed 63 patients with significant stenosis of the LAD and 50 patients without significant coronary artery disease. Echocardiography was done?≤48 h before angiography. Multilayer longitudinal strains were assessed from the endocardium, mid-myocardium and epicardium by 2D-STE. Regional longitudinal strain in LAD territory (RLS_LAD) was calculated as the mean peak systolic longitudinal strain of segments subtended by the LAD for all myocardial layers. Significant differences were observed in all strain parameters between the two groups. RLS_LAD and global longitudinal strain in the endocardium showed higher accuracy than that in the mid-myocardium and epicardium, wall motion score index (WMSI), WMSI in LAD territory, and EF for detection of significant LAD stenosis (all P?<?0.05), with areas under the receiver operating characteristic curve of 0.87 and 0.91, respectively. An endocardial RLS_LAD cutoff of ?23.52?% showed optimal sensitivity and specificity (88.9/80.0?%). In patients with suspected NSTE-ACS, multilayer longitudinal strain analysis at rest might enable prediction of significant LAD stenosis, and could help to identify patients requiring reperfusion.     

长期小剂量克拉霉素联合鼻用激素治疗慢性鼻-鼻窦炎的临床疗效分析

目的 探讨长期小剂量克拉霉素联合鼻用激素治疗慢性鼻-鼻窦炎（CRS）的临床疗效.方法 选取2009年8月至2011年8月于长葛市人民医院进行治疗的94例CRS患者,将其随机分为常规治疗组（对照组）和长期小剂量克拉霉素联合鼻用激素组（观察组）,每组各47例.将两组患者不同分型及总数的总有效率、治疗前后的不同症状评分进行比较.结果 观察组的上述指标评估结果均明显优于对照组,差异均有统计学意义（P＜0.05）.结论 长期小剂量克拉霉素联合鼻用激素治疗CRS的临床疗效好,对于各种症状的改善非常明显.     

Cytokine release syndrome and relevant factors of CD19 targeted chimeric antigen receptor T cell therapy in relapsed/refractory B cell hematological malignancies

Objectives and methodsWe reviewed the outcomes of 77 episodes of CD19 CAR-T therapy in 67 patients with B cell hematological malignancies from October 2016 to January 2020. Factors related to the grade of cytokine release syndrome (CRS) were explored by multivariate analysis, nonparametric test was conducted to explore the correlation between CRS and response. Kaplan–Meier curves were used to indicate survival profiles, and the correlation between CRS and survival was determined by the log-rank test.ResultsThe rate of complete remission (CR) was 74.0% (57/77). CRS of any grade occurred in 68 of 77 episodes (grade 1: 32.5%, grade 2: 24.7%, grade 3: 22.1%, grade 4: 6.5%, grade 5: 2.6%). Patients with a history of transplantation had less severe CRS, and dose escalation-based infusion reduced the severity of CRS. Severe CRS was related to a higher CR rate but had no significant impact on event-free survival (EFS), relapse-free survival (RFS), or overall survival (OS).ConclusionAs a common adverse reaction of CAR-T therapy, the severity of CRS can be alleviated by dose escalation infusion, a history of transplantation was correlated with less severe CRS. Severe CRS was related to better response but was unrelated to long-term survival.     

Early diastolic strain rate predicts response to heart failure therapy in patients with dilated cardiomyopathy

The aim of this prospective study was to assess the value of speckle tracking echocardiographic (2D-STE) parameters to predict response to heart failure therapy in patients with dilated cardiomyopathy (DCM). Eighty-seven patients (mean age 51 ± 13 years) with DCM, defined as ejection fraction (EF) <45 %, left ventricular (LV) end-diastolic diameter >112 % of normal range derived from age and body surface area. Based on 2D-STE following parameters were extracted from three apical views of the LV: global longitudinal strain, systolic and diastolic strain rate (SR_E). Mechanical dispersion was calculated as standard deviation of time-to-peak strain values including all LV segments. After receiving heart failure therapy (mean 39 ± 11 months, range 3–60 months) 50 patients reached combined endpoint defined as following: death, heart transplantation, rehospitalization due to heart failure, and absence of improvement in EF. On stepwise multivariate regression analysis, SR_E was independently of EF and LV volumes predictive for combined endpoint (OR 0.44, 95 %CI 0.27–0.70, p = 0.001) with an area under the ROC-curve (AUC) of 0.91. In patients with cQRS duration ≤120 ms mechanical dispersion was predictive for combined endpoint with the highest AUC (OR 1.53, 95 %CI 1.08–2.16, p = 0.002; AUC = 0.94). In this study, SR_E, a surrogate parameter of myocardial relaxation, was able to predict a response to heart failure therapy in patients with DCM. In patients with narrow QRS complex, mechanical dispersion yielded the highest predictive value. Parameters of 2D-STE may contribute to risk stratification in this patient population.     

二维超声斑点追踪预测充血性心力衰竭患者心脏再同步化治疗的急性期反应

目的 观察二维超声斑点追踪(2D-STE)是否可预测充血性心力衰竭患者心脏再同步化治疗(CRT)的急性期反应.方法 24例充血性心力衰竭患者接受CRT治疗,术后7天分别在CRT关闭(OFF)和开启(ON)状态接受超声检查.将2D-STE测量的左心室短轴前间壁和后壁达峰值径向应变的时间差(T_(AS-POST))≥130 ms定义为左心室收缩不同步.将CRT-ON时左心室压力最大上升速率(LVdp/dt)的增长率Δdp/dt%>25%定义为急性反应有效.结果 15例患者(62.50%) CRT有反应,CRT-ON时左心室射血分数和LVdp/dt增大,T_(AS-POST) 缩短.T_(AS-POST) 是预测Δdp/dt%>25%的独立因素,T_(AS-POST)≥130 ms预测CRT急性反应的敏感度和特异度分别为86.24%和70.38%.结论 2D-STE技术能够有助于选择CRT最适病例,并预测其急性期反应.