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　　最近美国克里夫兰临床中心的Zoran B Popovic等人研究发现，扩张型心肌病（DCM）患者更易出现心脏的长轴运动（LR），且LR是心脏再同步化治疗（CRT）患者收缩末期容积下降的预测因子。研究结果发表在7月30日《Heart》在线版。

　　准备行CRT的心力衰竭患者常常会出现LR——在水平长轴平面上观察到的心脏摆动。Zoran B Popovic等为了明确缺血性心肌病（ICM）和DCM患者中LR的幅度和预测因素，评估LR对接受CRT患者的预测价值，对拟行CRT的45名ICM患者、41名DCM患者以及16名对照者进行了心脏超声检查。采用超声斑点跟踪显像技术测量总体LR、局部应变和局部LR。其中64名患者在接受CRT40天后复查心脏超声。

　　结果显示，QRS宽度 <130 ms 和 ≥130 ms 的DCM患者都显示了明显的顺钟向LR（p <0.001 for both vs. 0），ICM患者和对照组也有LR，但不显著。最常见的LR预测因素是舒张末期容积（P<0.0001），其次是无局部缺血（p<0.0001）和QRS宽度（p=0.05）。与LR不太明显的DCM患者或逆钟向LR的ICM患者相比，LR明显的DCM患者间隔应变力较低，而侧壁应变力较高。在DCM患者中，LR与收缩末期容积相关（r = 0.49, p = 0.004），而在ICM患者中未发现这种相关性。

　　因此，作者认为，顺钟向LR与DCM相关，对QRS宽度影响较小。LR是DCM患者CRT期间收缩末期容积下降的中等强度的预测因子。

　　Heart. Published Online First: 30 July 2007. doi:10.1136/hrt.2007.122192

　　Longitudinal Rotation: An Unrecognized Motion Pattern in Patients with Dilated Cardiomyopathy

　　Background Heart failure patients who are candidates for CRT frequently display longitudinal rotation (LR)-a swinging motion of the heart when imaged in a horizontal long-axis plane.

　　Objectives To identify the magnitude and predictors of LR in patients with ischemic (ICM) and idiopathic dilated (DCM) cardiomyopathy, and to assess predictive value of LR in patients undergoing cardiac resynchronization therapy (CRT). Design and setting: a retrospective study in a tertiary heart care setting

　　Methods We performed echocardiography in 45 ICM and 41 DCM patients who were CRT candidates and 16 control subjects. Global LR, segmental strains and segmental LR were assessed from echocardiograms using speckle tracking. Repeat echocardiography >40 days after the beginning of CRT was performed in 64 patients.

　　Results While DCM patients with QRS duration of both <130 ms and (3)130 ms displayed significant clockwise LR (p <0.001 for both vs. 0), ICM patients and control subjects had LR that did not differ from 0. Most significant LR predictor was end-diastolic volume (P<0.0001) followed by the absence of ischemia (p<0.0001) and QRS duration (p=0.05). DCM patients with prominent clockwise LR had lower septal but higher lateral strains than DCM patients with minimal LR, or ICM patients with counterclockwise LR. LR correlated with decrease of end-systolic volume in DCM (r = 0.49, p = 0.004), while no relationship was observed in ICM.

　　Conclusion Clockwise LR is linked to presence of DCM, with the small impact of QRS duration. LR is moderately strong predictor of end-systolic volume decrease during CRT in DCM.

　　http://heart.bmj.com/cgi/content/abstract/hrt.2007.122192v1