transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2023-10-1-14-24transmed-750Research ArticleСЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯCARDIOVASCULAR MEDICINEТрехмерная эхокардиография в режиме реального времени в оценке левожелудочковой диссинхронииReal-time three dimensional tte in quantification of left ventricular dyssynchronyhttps://orcid.org/0000-0003-2852-0684МамедоваА. И.MamedovaA. I.

Мамедова Арзу Исрафил кызы, аспирант ФГБУ «НМИЦ им. В. А. Алмазова» Минздрава России

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Arzu I. Mamedova, post-graduate student, Almazov National Medical Research Centre

Akkuratova str., 2, Saint Petersburg, 197341

arzu.mamedova.phd@gmail.comПриходькоН. А.Prihod’koN. A.

Приходько Никита Андреевич, младший научный сотрудник НИЛ клинической аритмологии 

Санкт-Петербург

Nikita A. Prikhodko, junior researcher, Research Laboratory of Clinical Arrhythmology

Saint Petersburg

ЛюбимцеваТ. А.LubimcevaT. A.

Любимцева Тамара Алексеевна, кандидат медицинских наук, старший научный сотрудник НИЛ клинической аритмологии

Санкт-Петербург

Tamara A. Lyubimtseva, MD, Senior Researcher, Research Laboratory of Clinical Arrhythmology

Saint Petersburg

КозленокА. В.KozlenokA. V.

Козленок Андрей Валерьевич, кандидат медицинских наук, заведующий НИО физиологии кровообращения 

Санкт-Петербург

Andrey V. Kozlenok, MD, Head of Research Institute of Circulatory Physiology

Saint Petersburg

ЛебедевД. С.LebedevD. S.

Лебедев Дмитрий Сергеевич, доктор медицинских наук, главный научный сотрудник, руководитель НИО аритмологии 

Санкт-Петербург

Dmitry S. Lebedev, D.M.Sc., Chief   Researcher, Head of the Research and Development Department of Arrhythmology

Saint Petersburg

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская многопрофильная больница № 2»РоссияAlmazov National Medical Research Centre; Saint-Patersburg City Multiservice Hospital № 2Russian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииRussian FederationAlmazov National Medical Research CentreRussian Federation2023070420231011424Copyright © Мамедова А.И., Приходько Н.А., Любимцева Т.А., Козленок А.В., Лебедев Д.С., 20232023Мамедова А.И., Приходько Н.А., Любимцева Т.А., Козленок А.В., Лебедев Д.С.Mamedova A.I., Prihod’ko N.A., Lubimceva T.A., Kozlenok A.V., Lebedev D.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/750Актуальность

Актуальность. Основной проблемой при отборе пациентов на сердечную ресинхронизирующую терапию (СРТ) остается отсутствие единых подходов к определению механической диссинхронии (МД) и критериев отбора.

Цель

Цель. Выявить зависимость критериев диссинхронии у пациентов от метода и точки стимуляции и выявить корреляцию этих данных с шириной комплекса QRS и процентом глобальной двухмерной продольной деформации.

Материалы и методы

Материалы и методы. В исследовании участвовало 12 пациентов (63–73,5 лет) с медикаментозно компенсированной ХСН II–IV класса, ФВ левого желудочка (ЛЖ) менее 35 % и длительностью комплекса QRS более 130 мс, имеющих показания к СРТ. Всем пациентам интраоперационно вводили ретроградно трансаортально управляемый электрод. Во время стимуляции каждой точки (88 точек) выполнялось чреспищеводное ЭхоКГ (ЧП ЭхоКГ). Для анализа данных использовалось ПО TomTec и Philips Qlab 3DQ Advanced.

Результаты

Результаты. Индексы сегментарной экскурсии и сократимости миокарда значимо различались в зависимости от точки стимуляции при анализе. Выявлена умеренная обратная корреляция между ExсAvg, ФВ ЛЖ и длительностью комплекса QRS. Показана умеренная прямая корреляция индекса диссинхронии SDI-16 с длительностью комплекса QRS и умеренная обратная корреляция этого индекса с ExсAvg и ФВ ЛЖ. Кроме того, выявлена умеренная обратная корреляция между показателями двухмерной продольной глобальной деформации и фракцией выброса.

Заключение

Заключение. Методика позволяет проводить оценку регионарной сократимости миокарда ЛЖ и может использоваться при отборе пациентов и сравнении альтернативных подходов к ЛЖ стимуляции для улучшения ответа на СРТ.

 

 

Background

Background. The main problem in the patient selection for cardiac resynchronization therapy (CRT) is the lack of unified approaches to the definition of mechanical dyssynchrony (MD) and selection criteria.

Objective

Objective. To reveal the dependence of the criteria of dyssynchrony in patients on the method and point of stimulation and to reveal the correlation of these data with the width of the QRS complex and the percentage of global two-dimensional longitudinal deformation.

Design and methods

Design and methods. The study involved 12 patients with drug-compensated CHF of class II-IV, LVEF< 35 % and a QRS duration >130 ms, having CRT indications. All patients were intraoperatively injected with a retrograde transaortically guided electrode. During stimulation of each point (88 points), transesophageal Echo-KG (PE Echo-KG) was performed. TomTec and Philips Qlab 3DQ Advanced software was used for data analysis.

Results

Results. The segmental excursion and myocardial contractility differed significantly depending on the stimulation point. A moderate inverse correlation was found between ExcAvg, LVEF and QRS duration. There were a direct correlation of the SDI-16 and the QRS duration was shown, and an inverse correlation of SDI-16 with ExcAvg and LVEF. 2D longitudinal global strain was inversely correlated with the EF.

Conclusion

Conclusion. The technique is useful for regional LV myocardial contractility assessment and patient selection and comparison of alternative approaches to LV pacing to improve response to CRT.

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The authors declare that there are no conflicts of interest present.