| 摘要: |
| 目的观察慢性收缩性心力衰竭(SHF)患者心脏收缩不同步的类型、发生比例,探讨QRS时限＞135 ms对心脏再同步化治疗(CRT)术前病例筛选的价值。方法45例入选的SHF患者根据QRS时限分为：宽QRS组(QRS≥120 ms,n=24),窄QRS组(QRS＜120 ms,n=21),采用体表心电图、常规超声心动图和组织多普勒来评价各组患者心脏收缩不同步的情况；以135 ms作为截断值,评价优化的QRS时限对SHF患者心脏机械收缩不同步的诊断价值。结果心功能指标：与窄QRS组相比,宽QRS组患者LVEDD、 LVEDV升高(P=0.03、0.01),LVEF降低(P=0.004)；宽QRS组患者NYHA分级升高(P=0.002),利尿剂及洋地黄类药物使用率明显增加(P=0.01)。心脏机械收缩不同步指标：与窄QRS组相比,宽QRS组患者室间不同步比例明显升高(70.8% vs 15%,P<0.000 1),IVMD值亦明显升高(P<0.000 1)；宽、窄QRS组患者室内不同步发生率均较高(79.2% vs 71.4%),组间无统计学差异(P=0.55)；宽QRS组APET显著延长(P<0.000 1)；两组患者其余指标(Ts-SD、Ts-12、SPWMD等)均无统计学差异。相关性分析显示：QRS时限与室间不同步发生显著相关 (r=0.58,P<0.000 1),但与室内不同步却相关不明显(r=0.07,P=0.64)。ROC曲线分析：以QRS时限＞135 ms诊断室间不同步的敏感性和特异性分别为80%和87.5%；但评价室内不同步的敏感性为44.1%,特异性为73.6%。结论SHF患者人群存在较高比例的心室机械收缩不同步；QRS时限＞135 ms能较好地评价心室间机械收缩不同步,可能对优化CRT术前病例筛选有一定价值。 |
| 关键词: QRS时限 收缩性心力衰竭 不同步 超声心动描记术 |
| DOI：10.3724/SP.J.1008.2010.0161 |
| 投稿时间：2009-05-25修订日期：2009-12-27 |
| 基金项目: |
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| QRS duration in evaluating ventricular dyssynchrony in patients with chronic systolic heart failure |
| GUI Yan-ping, LIAO De-ning, ZHANG Jia-you* |
| (Department of Cardiology, Changzheng Hospital, Second Mililary Medical University, Shanghai 200003, China) |
| Abstract: |
| ObjectiveTo observe the types, prevalence of cardiac dyssynchrony in patients of chronic systolic heart failure (SHF) , and to investigate the value of QRS duration >135 ms in selecting patients for cardiac resynchronization therapy (CRT). MethodsForty-five patients with SHF were randomly divided into two groups according to QRS width: Group 1 (QRS width ＜120 ms, 21 patients) and Group 2 (QRS width ≥120 ms, 24 patients). Electrocardiography, conventional echocardiography, and tissue doppler were performed in all patients to evaluate the cardiac systolic dyssynchrony. Meanwhile, the diagnostic value of optimized QRS width to evaluate the dyssynchrony indices was tested while using 135 ms as new cutoff value. ResultsSystolic function: compared with Group 2, Group 1 had significantly higher LVEDD and LVEDV(P=0.03 and 0.01, respectively), lower LVEF(P=0.004), and had significantly higher NYHA class(P=0.002)and more frequent use of diuretics and digoxins(P=0.01,both). Dyssynchrony parameters: Group 2 had a significantly higher prevalence of interventricular dyssynchrony(70.8% vs 15%,P<0.000 1) and higher IVMD value(P<0.000 1) than Group 1; the prevalences of intraventricular dyssynchrony were high in both groups(71.4% vs 79.2%,P=0.55), except that the APET value was prolonged in Group 2. Other indices(Ts-SD, Ts-12, and SPWMD)showed no significant difference between the two groups. Correlation analysis: a strong correlation was found between QRS duration and interventricular dyssynchrony(r=0.58,P<0.000 1), while it was fairly poor between QRS duration with intraventricular dyssynchrony(r=0.07,P=0.64).ROC analysis: QRS width ＞135 ms could finely predict the presence of interventricular dyssynchrony, with a sensitivity of 80% and a specificity of 87.5%; while the same cutoff value to predict intraventricular dyssynchrony only yielded a sensitivity of 44.1% and specificity of 73.6%.ConclusionIntraventricular dyssynchrony and(or) interventricular dyssynchrony has a high prevalence in patients with SHF. A QRS duration cutoff value higher 135 ms can well evaluate the cardiac mechanical dyssynchrony in clinical practice, which may be of value for optimizing selection of CRT candidates and reducing the nonresponders. |
| Key words: QRS duration systolic heart failure dyssynchrony echocardiography |
