左心室心肌做功预测心脏再同步化治疗的效果

目的利用二维斑点追踪成像(2D-STI)技术新参数左心室心肌做功预测心脏再同步化治疗(CRT)的效果。方法选取2017年12月至2019年10月在苏北人民医院接受CRT治疗的75例心力衰竭患者为研究对象,于CRT术前及术后6个月测量常规超声心动图参数以及利用2D-STI技术分析整体心肌做功参数。将术后左心室收缩末期容积(LVESV)缩小≥15%定义为CRT治疗有效。采用SPSS 25.0软件进行统计分析,变量间相关性采用Spearman相关性分析。应用ROC曲线分析各参数预测CRT的效果。结果CRT的有效率为65%(49/75)。与术前比较,有效组术后左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)和LVESV减小,左心室射血分数(LVEF)增高,有效组术后心肌做功指数(GWI)、整体有效功(GCW)、整体做功效率(GWE)增高,整体无效功(GWW)降低(P<0.05);无效组各参数比较差异均无统计学意义。有效组术前GCW和GWW大于无效组(P<0.05)。GCW与左心室收缩末期容积减少率(△LVESV)及LVEF呈线性相关(r=0.58,0.64;均P<0.05);GCW、GWW预测CRT疗效的ROC曲线下面积为0.78与0.85。结论左心室心肌做功参数可评估CRT患者左心室收缩功能,并可预测CRT患者的治疗效果。

Predicting response to cardiac resynchronization therapy by global left ventricular myocardial work

Objective To evaluate left ventricular myocardial work(LVMW)in predicting response to cardiac resynchronization therapy(CRT)using innovative two-dimensional speckle tracking imaging(2D-STI)technology.Methods From December 2017 to October 2019,75 patients with heart failure received CRT in Northern Jiangsu People′s Hospital were selected.Conventional echocardiography was performed before and 6 months after CRT,and global LVMW index(LVMWI)was analyzed with 2D-STI.Patients were defined as responders if a reduction over 15%was observed in left ventricular end-systolic volume(LVESV)after CRT.SPSS statistics 25.0 was used for statistical analysis,and the correlation between variables was analyzed using Spearman correlation.The receiver operating characteristic(ROC)curve was employed to analyze the predictive value of different parameters for the therapeutic effects of CRT.Results The effective rate of CRT was 65%(49/75).Compared with before operation,the responders had lower left ventricular end-diastolic dimension(LVEDD),left ventricular end-diastolic volume(LVEDV)and LVESV,higher left ventricular ejection fraction(LVEF),higher myocardial work index(GWI),higher global effective work(GCW),higher global work efficiency(GWE),and lower overall invalid work(GWW)after the intervention(P<0.05).There were no statistically significant differences in those parameters in the non-responders.Preoperative GCW and GWW were higher in the responders than the non-responders(P<0.05).GCW was linearly correlated with△LVESV and LVEF(r=0.58,0.64;P<0.05 for both).The area under the ROC curve was 0.78 for GCW and 0.85 for GWW in predicting CRT responders(P<0.05).Conclusion The left ventricular myocardial work index can evaluate the left ventricular systolic function in the CRT patients and can be used to predict the response to CRT.