Research On The Evaluation Of The Curative Effect Of Cardiac Resynchronization Therapy In Patients With Heart Failure Using The Longitudinal Strain Parameters Of 3D-STE

Objective:To evaluate the preoperative and postoperative changes in the synchronization of left ventricular myocardial motion using longitudinal strain parameters of 3D-STE,to investigate the correlation between longitudinal strain and CRT responsiveness,to predict the clinical value of short or medium-term curative effect of CRT,and to better explore the operation indications and prognosis of patients with heart failure and undergone CRT treatment.Methods:20 cases of patients with heart failure and undergone CRT treatment were selected and followed up for 6 months.The QRS duration of ECG,LVEDV,LVESV,LVEF,exercise tolerance(6-minute walking distance),NT-BNP and other indexes of the patients before operation and 1,3 and 6 months after operation were measured.Besides,analysis of conventional ultrasonic cardiogram and 3D-STI was conducted to get the peak strain parameters in myocardial longitudinal contraction period(GLS),the maximum difference of time to peak of the longitudinal strain(L-Max-Ts)and the standard deviation(L-Ts-SD)of the 16 segments of the left ventricle.The differences between the above indexes before and after operation were compared,and correlation analysis of the above indexes was conducted.In addition,20 normal volunteers were selected as control group,whose age and sex matched with the heart failure patients.Results:1.The difference comparison of the preoperative parameters of the three groups showed that the difference in the distribution of all parameters among the three groups was statistically significant(P<0.05).The results of pairwise comparison showed that the preoperative L-Max-Ts and L-Ts-SD of CRT response group were larger than those of CRT invalid group and control group;the preoperative L-Max-Ts and L-Ts-SD of CRT invalid group were larger than those of control group;the difference was statistically significant(P<0.05).The difference in QRS wave width and EF between CRT response group and CRT non-response group was not statistically significant(P>0.05).The difference in other parameters between the two groups was statistically significant(P<0.05).2.There was no significant difference in QRS wave width except for 3 months and 6 months after operationin in CRT non-response group.Difference was found in GLS except for 3 months and 6 months after operation in CRT non-response group(P<0.05).The difference in L-Max-Ts and L-Ts-SD between before operation and 1 month,3 months and 6 months after operation had no significant statistical significance(P>0.05).3.The differences in GLS,L-Max-Ts and L-Ts-SD between various time points in CRT response group were statistically significant(P<0.05).Except for 3 months and 6 months after operation,there was significant difference in LVEDV.The differences in LVESV,EF and BNP between various time points in the 6-minute walking test were statistically significant(P<0.05).4.The comparison of 3D-STI index between CRT response group and CRT non-response group showed that there was difference in L-Ts-SD between the two groups at 3 months and 6 months after operation(P<0.05).The differences in GLS and L-Max-Ts between the two groups at 1 month,3 months and 6 months after operation were statistically significant(P<0.05).5.ROC results showed that the CRT curative effect curve area predicted by L-Max-Ts,L-Ts-SD and GLS before operation was 0.833,0.869 and 0.786,respectively.Thereinto,the preoperative area of L-Ts-SD under the curve was the largest(AUC=0.869).When L-Ts-SD cutoff value was 1 13.5 before operation,it is predicted that the acuity of CRT curative effect was 85.7%and the specificity was 83.3%.Conclusions1.Cardiac resynchronization therapy can significantly improve the clinical symptoms of patients with chronic heart failure,reverse myocardial remodeling and reduce mortality.2.The asynchronization degree of preoperative left ventricular myocardial motion in CRT respondents is worse than that in non-responders,and QRS wave duration cannot perfectly represent the asynchronization of cardiac mechanical motion.3.3D-STE can accurately evaluate the synchronization of left ventricular myocardial motion in patients with heart failure and evaluate the improvement status of left ventricular myocardial contraction after CRT.4.3D-STE can effectively predict the short to mid-term curative effect of CRT,and L-Ts-SD is an effective index to predict the curative effect.