Additional value of three-dimensional echocardiography in patients with cardiac resynchronization therapy

作者：Deplagne Antoine; Bordachar Pierre^*; Reant Patricia; Montaudon Michel; Reuter Sylvain; Laborderie Julien; Dos Santos Pierre; Roudaut Raymond; Jais Pierre; Haissaguerre Michel; Laurent Francois; Clementy Jacques; Lafitte Stephane

来源：Archives of Cardiovascular Diseases, 2009, 102(6-7): 497-508.

DOI：10.1016/j.acvd.2009.03.013

• Cardiac resynchronization therapy
• Echocardiography
• Dyssynchrony
• 3-dimensionnal

Background. - There is no gold standard technique for quantification of ventricular dyssynchrony.
Aim. - To investigate whether additional real-time three-dimensional morphologic assessment of ventricular dyssynchrony affects response after biventricular pacing.
Methods. - Forty-one patients with severe heart failure were implanted with a biventricular pacing device and underwent two-dimensional (time dispersion of 12 left ventricular electromechanical delays) and three-dimensional echocardiographic assessment of ventricular dyssynchrony (dispersion of time to minimum regional volume for 16 left ventricular segments), before implantation, 2 days postimplantation with optimization of the pacing interventricular delay and 6 months postimplantation.
Results. - Individual optimization of sequential biventricular pacing based on three-dimensional ventricular dyssynchrony provided more improvement (p < 0.05) in left ventricular ejection fraction and cardiac output than simultaneous biventricular pacing. During the different configurations of sequential biventricular pacing, the changes in three-dimensional ventricular dyssynchrony were highly correlated with those of cardiac output (r = -0.67, p < 0.001) and ejection fraction (r = -0.68, p<0.001). The correlations between two-dimensional ventricular dyssynchrony and cardiac output or ejection fraction were significant but less (r = -0.60, p < 0.01 and r = -0.56, p < 0.05, respectively). After 6 months, 76% of patients were considered responders (10% decrease in end-systolic volume). Before implantation, we observed a significant difference between responders and non-responders in terms of three-dimensional (p < 0.05) - but not two-dimensional - ventricular dyssynchrony.
Conclusion. - This prospective study demonstrated the additional value of three-dimensional assessment of ventricular dyssynchrony in predicting response after biventricular pacing and optimizing the pacing configuration.

• 出版日期2009-7
• 单位河南工业大学