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Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

机译：斑点跟踪超声心动图在心脏再同步治疗中的临床应用

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AbstractCardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference (‘speckles’) in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
机译：摘要心脏再同步治疗（CRT）可以显着改善某些心力衰竭患者的预后。但是，反应难以预测，多达三分之一的患者可能没有反应。对左心室不同步的超声心动图评估引起了极大的兴趣，其最终目的是可靠地确定对CRT有反应的患者。心肌变形（应变）的测量通常使用组织多普勒成像（TDI）进行评估，该技术受到角度依赖性和在单个平面中测量的能力的限制。二维斑点跟踪超声心动图技术是一种通过跟踪整个心动周期在心肌壁中超声干扰（“斑点”）模式来提供三个平面应变测量的技术。自从15年前首次使用以来，它已成为一种工具，可以提供比TDI更强大，可重现和敏感的不同步标记。本文回顾了二维和三维斑点跟踪超声心动图在不同步性评估中的应用，包括鉴定可能具有预测CRT反应潜力的超声心动图参数。它还回顾了这些技术在指导植入前最佳LV导线放置中的应用，并在CRT后的临床改善中取得了可喜的成果。

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