心脏再同步化治疗慢性充血性心力衰竭患者舒张功能的评价  

The long-term effects of cardiac resynchronization therapy on left ventricular diastolic function in patients with congestive heart failure

作　　者：白静[1] 刘华芬[1] 江洪[1] 郭瑞强[2] 孙有刚[2] 陈葵[1] 

机构地区：[1]武汉大学人民医院心内科,武汉市430060 [2]武汉大学人民医院超声科,武汉市430060

出　　处：《临床超声医学杂志》2008年第6期368-370,共3页Journal of Clinical Ultrasound in Medicine

基　　金：湖北省"十一五"攻关项目(2006A301A04)

摘　　要：目的应用超声心动图评价心脏同步化治疗对重度心衰患者左室舒张功能的长期影响。方法18例左室非同步的慢性充血性心衰患者行心脏同步化治疗。并于治疗前,治疗后1周、6个月、12个月行超声心动图检查,测量左室射血分数(LVEF),二尖瓣血流E、A峰值,应用组织多普勒技术测量二尖瓣瓣环收缩期峰值速度(Sm),舒张早期峰值速度(Em),舒张晚期峰值速度(Am)。结果起搏后第1周LVEF明显高于起搏前(P<0.001)。二尖瓣环间隔部Am术后6个月[(11.3±2.9)cm/s]、1年[(12.5±3.6)cm/s]明显高于起搏前[(9.2±1.7)cm/s](P<0.05)。二尖瓣环侧壁Am术后6个月[(12.1±3.2)cm/s]和术后1年[(13.5±3.2)cm/s]高于起搏前[(11.8±2.9)cm/s](P<0.05)。二尖瓣环间隔部Em起搏前后未见显著性变化。结论超声心动图是评价心脏同步化治疗左室运动不同步的心衰患者舒张功能明显改善的一种可靠方法。Objective To detect the long- term effects of cardiac resynchronization therapy（CRT）on left ventricular diastolic function in patients with congestive heart failure. Methods Eighteen patients with congestive heart failure were treated with CRT. Left ventricular ejection fraction（LVEF）, the peak transmitral velocities during early（E - wave） and late （A- wave） diastolic filling were measured before and at 1st week, 6th month, 12th month after therapy by echocardiography. In order to detect the changes of left ventricular diastolic function,mitral annulus velocities were measured with tissue Doppler imaging（TDI） at septal and lateral annulus, respectively. Systolic velocity（Sm）, early（Em） and late（Am） diastolic mitral annulus velocities were obtained. Results LVEF increased significantly from （24±8）% to （27±7）% （P 〈 0. 001） after CRT at the first week. The septal Am velocity increased from （9.2±1.7） cm/s to （11.3±2.9） cm/s after CRT at 6th month（P 〈 0.05）, and increased to （12.5±3.6） cm/s at 12th months （P 〈 0.05）. The lateral Am velocity increased from （ 11. 8±2.9） cm/s to （ 12.1±3.2） cm/s after CRT at 6th month（P 〈 0.05）, and further increased to （ 13.5 ± 3.2） cm/s at 12th month（ P 〈 0.01 ） . The Em velocity didn＇t change significantly after CRT. Conclusion CRT can markedly improve left ventricular diastolic function of patients with congestive heart failure induced by mechanical dyssynchrony.

关 键 词：超声心动描记术 心脏同步化治疗 心力衰竭 

分 类 号：R541.62[医药卫生—心血管疾病] R544.1[医药卫生—内科学]