缺血性与非缺血性心肌病左心室延迟收缩的比较研究  

Comparative study on left ventricular dyssynchrony in ischemic or nonischemic cardiomyopathy population

作　　者：孙雅萍[1] 史浩颖[1] 刘健[1] 舒先红[2] 陈灏珠[2] 

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080 [2]上海市心血管病研究所,复旦大学附属中山医院心内科,上海200032

出　　处：《生物医学工程与临床》2008年第5期393-396,共4页Biomedical Engineering and Clinical Medicine

摘　　要：目的应用组织多普勒探讨左心室延迟收缩模型是否与缺血病因相关。方法选择74例正常人,年龄(40±14)岁,66%男性;48例非缺血性心肌病患者,年龄(55±12)岁,63%男性,QRS宽度(148±35)ms,52%完全性左束支传导阻滞,左心室射血分数(LVEF)29%±10%;43例缺血性心肌病患者,年龄(58±12)岁,64%男性,QRS宽度(151±28)ms,44%完全性左束支传导阻滞,LVEF31%±13%。分别进行组织多普勒检查。测量12个左心室节段中QRS起始到收缩速度峰值的时间间期(Ts),计算其标准差(Ts-SD)为心室内失同步参数,并计算各节段间Ts的差值。结果正常组、非缺血性心肌病组和缺血性心肌病组的Ts-SD分别为(22.7±10.5)ms、(45.3±15.6)ms和(45.5±17.0)ms。正常组下壁和后壁的Ts显著长于侧壁和前壁[(154.0±34.2)ms、(151.1±32.3)ms比(129.6±29.0)ms,(124.9±24.9)ms;P<0.05]。在非缺血性心肌病和缺血性心肌病组中,各节段的Ts均较正常组延长(P<0.05)。在非缺血性心肌病组,下壁的Ts最长,前壁的Ts最短。收缩最延迟位于左心室下壁、后壁、侧壁和其他室壁的比例分别为42%、26%、16%、16%。在缺血性心肌病组,收缩最延迟位于左心室下壁、后壁、侧壁和其他室壁的比例分别为13%、31%、25%、31%。两组的构成比差异存在统计学意义(P<0.05)。结论缺血性心肌病组和非缺血性心肌病组的左心室延迟收缩部位不同。Objective To study the correlation between left ventricular dyssynchrony and ischemic etiology. Methods Seventy- four normal subjects [ aged （ 40 ± 14） years, male 66 % ], 48 nonischemic cardiomyopathy patients [ aged （55 ± 12 ） years, male 63 % ] and 43 ischemic cardiomyopathy patients [ （58 ± 12） years ,male 64 % ] were performed color Doppler echography. The QRS interval and peak systolic velocity was measured from the myocardial velocity curves in 12 standard basal and middle segments, and the standard deviation （Ts-SD） was used as a parameter of intraventricular dyssynchrony. The Ts among different segments were compared in each group of patients. Results The Ts-SD in normal subjects,nonischemic cardiomyopathy and isehemic cardiomyopathy patients were （22.7 ± 10.5） ms, （45.3 ± 15.6） ms and （45.5 ± 17.0） ms respectively. In normal subjects,the Ts of the inferiorwall and posterior septum were significantly longer than that of lateral wall and anterior wall [（154.0 ±34.2） ms, （151.1 ± 32.3） ms vs （129.6 ± 29.0） ms, （124.9 ± 24.9） respectively;P 〈 0.05]. In patients with heart failure the Ts of each segment was prolonged compared with that in normal subjects. In nonischemie cardiomyopathy patients the Ts of the inferior wall was significantly delayed and longer than the lateral wall,anterior septum and the anterior wall [（244.2 ± 60.9） ms vs （208.5 ± 68.1 ） ms, （199.1 ± 49.7） ms, （192.6 ± 52.2） ms respectively;P 〈 0.05]. In the isehemic cardiomyopathy patients,although the increased Ts-SD indicated marked intraventricular dyssynchrony no significant differences of Ts were found among the lateral wall,inferior wall and posterior wall, which might be due to the heterogeneous patterns of regional wall motion delay in the ischemic cardiomyopathy patients. Conclusion The pattern of wall motion delay is less predictable and more variable in isehemic cardiomyopathy patients than that in nonischemic patients.

关 键 词：超声心动图描记术 组织多普勒 心力衰竭 心脏失同步 

分 类 号：R541.6[医药卫生—心血管疾病]