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目的评价左右室收缩功能对心脏再同步化治疗(CRT)效果的预测价值。方法选取2011年1月1日~2015年5月31日因心功能不全在解放军总医院植入CRT的患者50例。收集患者的临床资料测定术前和术后6个月的超声心动图指标,测定指标包括左室长轴应变(LVSLS)、右室长轴应变(RVSLS)等。按照CRT的超声反应标准进行分组,分为CRT治疗有反应组(n=31)和无反应组(n=19),首先通过单因素分析和多因素分析,分析VVI参数与CRT治疗效果的相关性,在此基础上进一步通过受试者工作特征曲线(ROC)分析得出各参数指标ROC下的面积(AUC)和截断点,再分别计算各参数单独和联合预测CRT有效性的灵敏度、特异度和准确度。结果1LVSLS、RVSLS与CRT治疗效果有相关性,多因素Logistic回归模型分析,发现LVSLS〔OR 3.45 CI(2.47-10.86),P<0.01〕,RVSLS〔OR 3.01 CI(1.98-4.66),P<0.01〕。2 VVI参数预测价值部分,LVSLS的AUC为0.722(P<0.01),RVSLS的AUC为0.703(P<0.01),串联试验后AUC最大,为0.798(P<0.01),选定的截断点分别为LVSLS>9.7%,RVSLS>16.8%。分别计算其灵敏度、特异度和准确度,LVSLS的上述指标分别是90%、42%和72%;RVSLS分别是87%、53%和74%;LVSLS和RVSLS串联试验分别是84%、68%和78%。结论左右心室收缩功能与CRT治疗效果有相关性,串联左右心室长轴峰值应变指标预测CRT治疗效果优于单一指标。
Objective To evaluate the predictive value of left ventricular systolic function in cardiac resynchronization therapy (CRT). Methods From January 1, 2011 to May 31, 2015, 50 patients with CRT underwent cardiac insufficiency in People’s Liberation Army General Hospital. The clinical data of patients were collected to determine the echocardiographic parameters before and 6 months after operation. The measured parameters include left ventricular long axis strain (LVSLS) and right ventricular long axis strain (RVSLS). The patients were divided into CRT-treated group (n = 31) and non-responder group (n = 19) according to CRT’s standard of ultrasound. First of all, univariate analysis and multivariate analysis were used to analyze the correlation between VVI parameters and CRT treatment effect Based on this, the area under the ROC (AUC) and the cut-off point of each parameter index were further analyzed by the receiver operating characteristic curve (ROC), and the sensitivity of each parameter alone and in combination to predict the validity of CRT was calculated. Degree and accuracy. Results There was a correlation between 1LVSLS and RVSLS and CRT. Logistic regression analysis showed that LVSLS 〔OR 3.45 CI (2.47-10.86), P <0.01〕, RVSLS 〔OR 3.01 CI (1.98-4.66), P <0.01 ]. The AUC of LVSLS was 0.722 (P <0.01). The AUC of RVSLS was 0.703 (P <0.01), and the maximum AUC after series test was 0.798 (P <0.01). The selected cut-off points were LVSLS> 9.7%, RVSLS> 16.8%. The sensitivity, specificity and accuracy of LVSLS were calculated respectively. The above indexes of LVSLS were 90%, 42% and 72% respectively. The RVSLS were 87%, 53% and 74% respectively. The series of LVSLS and RVSLS were 84% and 68% And 78%. Conclusion The systolic function of left ventricle and right ventricle is related to the therapeutic effect of CRT. The peak strain index of long axis of ventricular systole is better than single index in predicting CRT.