- 期刊
Left Ventricular Dyssynchrony Occurs Frequently in Patients with Coronary Artery Disease
左心室收縮不同步常見於冠狀動脈疾病患者
摘要
Background: Left ventricular (LV) dyssynchrony is an independent predictor of cardiac events or death in patients with coronary artery disease (CAD). Assessment of LV dyssynchrony has been approached with phase analysis of ECG-gated SPECT myocardial perfusion imaging (MPI). The aims of this study are to evaluate the prevalence of LV dyssynchrony in patients with CAD and to determine factors associated with LV dyssynchrony. Methods: Seventy consecutive patients with CAD underwent T1-201 gated SPECT MPI were enrolled in this retrospective study. Seventy patients with low likelihood of CAD and normal gated SPECT MPI were enrolled as normal group. LV perfusion, function, and mechanical synchrony parameters were calculated using QPS® and QGS® software package. The upper limit of LV mechanical synchrony parameters phase histogram bandwidth (PHB) and phase standard deviation (PSD) values were defined as the mean plus 2 standard deviations of the normal group. Results: The upper limit of PHB and PSD were 49.4° and 12.5°, respectively. The prevalence of LV dyssynchrony in CAD patients was 31% (22/70). The CAD patients with LV dyssynchrony had higher percentage of prior myocardial infarction and fixed defect, higher rest heart rate, larger LV volume indices, and lower LV ejection fraction (LVEF) than those without LV dyssynchrony. There was a significant negative correlation between LVEF and LV mechanical synchrony parameters. A multivariate analysis revealed that rest heart rate, total perfusion defect of stress images, and LV volume were independent factors associated with LV dyssynchrony in patients with CAD. Conclusion: LV dyssynchrony occurred frequently in patients with CAD. LV dyssynchrony was significantly associated with functional and morphological deterioration. Increased rest heart rate, larger total perfusion defects, and dilated LV chamber cavity were independent factors of LV dyssynchrony in patients with CAD.
並列摘要
背景：左心室收縮不同步性是冠狀動脈疾病患者發生心臟事件或死亡的獨立預測因子，心電圖柵式單光子斷層心肌灌注造影的相位分析可用來評估左心室收縮不同步性。在這個研究中，我們針對冠狀動脈疾病患者，分析其左心室收縮不同步的盛行率，以及探討左心室收縮不同步的關聯因子。方法：此回溯性研究包含七十位確診冠狀動脈疾病患者，在本院接受鉈-201心電圖柵式單光子斷層心肌灌注造影，另外七十位低度風險且心肌灌注檢查結果正常的病患則作為正常組。利用QPS®與QGS®軟體計算左心室心肌灌流、功能、以及同步收縮等參數。左心室同步收縮之兩個指標：相位頻寬（PHB）與相位標準差（PSD）的正常值上限定義為正常組的平均值加兩個標準差。結果：相位頻寬與相位標準差的正常值上限各為49.4度與12.5度，左心室收縮不同步於冠狀動脈疾病患者之盛行率為31％（22／70位）。冠狀動脈疾病患者中左心室收縮不同步者有較高比例的心肌梗塞病史以及固定性的灌流缺陷、較高的心率、較大的左心室體積指標、以及較低的左心室射出分率。而左心室射出分率則與左心室同步收縮的指標呈現顯著負相關。在多變量分析下，休息時的心率、壓力相心肌灌流缺損的程度、以及左心室體積三者皆為冠狀動脈疾病患者左心室收縮不同步的獨立關聯因子。結論：左心室收縮不同步常見於冠狀動脈疾病患者，左心室收縮不同步與左心室的功能以及形態的惡化有關。休息狀態下心率的增加、壓力相心肌灌注缺損的程度、以及擴張的左心室體積皆為冠狀動脈疾病患者左心室收縮不同步的獨立關聯因子。