二维斑点追踪成像评价慢性心力衰竭患者左心室收缩不同步及其与收缩功能的关系  

Assessment of left ventricular systolic asynchrony by two dimensional speckle-tracking imaging and its relationship with ejection fraction in patients with chronic heart failure

作　　者：黄君红[1] 谢明星[1] 王新房[1] 吕清[1] 王静[1] 贺林[1] 陈明[1] 张丽[1] 胡莉君[1] 王蕾[1] 丁琳灵[1] 李燕[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声诊断科湖北省分子影像重点实验室,武汉430022

出　　处：《中华超声影像学杂志》2009年第5期369-373,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用二维斑点追踪成像（2D-STI）技术评价慢性心力衰竭（CHF）患者左室的收缩不同步特征，并探讨其与心衰程度的关系。方法CHF组42例，其中CHF1组19例，35％〈左室射血分数（LVEF）≤50％；CHF2组23例，LVEF≤35％；正常对照组35例。常规超声心动图双平面Simpson法测量LVEF；应用2D-STI测量自心电图QRS波起点至左室在心尖长轴观上的收缩期纵向应变率达峰时间（Tsrsl）及胸骨旁短轴观上的径向和环向应变率达峰时间（Tsrsr，Tsrsc）。计算左室各节段达峰时间标准差（Tsrsl-SD，Tsrsr-SD，Tsrsc-SD）及任意两节段达峰时间最大差值（Tsrsl-diff，Tsrsr-diff，Tsrsc-diff）为判断收缩期不同步指标。结果与对照组相比，CHF1、CHF2组左室收缩不同步指标TsrslSD、Tsrsr-SD、Tsrsc-SD及Tsrsl—diff、Tsrsr-diff、Tsrscdiff均显著延长，差异具有统计学意义（P〈0．05）；与CHF1组比较，CHF2组上述不同步指标均延长，差异具有统计学意义（P〈0．05）。CHF组收缩不同步指标与LVEF值相关分析：2D-ST1收缩不同步指标Tssrl-SD、Tsrsr-SD、Tsrsc-SD与LVEF呈显著负相关（r=-0．904～0．912，均P〈0．05），Tsrsl-diff、Tsrsr-diff、Tsrsc-diff与LVEF亦呈显著负相关（r=-0．916～0．967，均P〈0．05），其中LVEF与2D-STI在径向和环向的不同步指标相关性大于纵向。结论2D-STI可检测CHF左室收缩不同步性，心力衰竭程度越重，2D-ST1不同步程度越重。Objective To assess the characteristics of left ventricular（LV） systolic dyssynchrony in patients with chronic heart failure （CHF） using two dimensional speckle tracking imaging（2DSTI） and validate the correlation between LV systolic dyssynchrony and its ejection fraction（EF） measured by traditional two dimensional echoeardiography. Methods Forty two patients with CHF, which were divided into group CHF1 with 35%〈EF≤50% and group CHF2 with EF≤35%, and 35 healthy subjects as control group were enrolled in this study. Two-dimensional echocardiography Simpson＇s method was used to measure EF of LV. The time from the onset of QRS complexes to systole peak strain rate from the longitudinal, radial and circumferential vectors（Tsrsl, Tsrsr, Tsrsc）was recorded and measured using 2D- STI, respectively. The standard deviation and the maximal temporal difference of Tsrsl, Tsrsr, Tsrsc（Tsrsl- SD,Tsrsr-SD,Tsrsc-SD,Tsrsl-diff,Tsrsr- diff, Tsrsc -diff）of 18 segments were calculated as indicator of LV systolic dyssynchrony. Results The indices of LV systolic dyssynchrony Tsrsl SD,Tsrsl-diff, Tsrsr-SD, Tsrsr diff,Tsrsc-SD,Tsrsc-diff in group CHF1 and CHF2 were significantly higher than those in the control group （ P %1）. 05）. Compared with group CHF1, those indices in CHF2 were significantly longer （ P 〈 0.05）. Meanwhile, Tsrsl SD, Tsrsr-SD, Tsrsc-SD（ r = - 0. 904 ～ 0.912, all P 〈0.05） and Tsrsl-diff, Tsrsr- diff, Tsrsc-diff（ r = - 0. 916～0. 967, all P 〈0.01 ） had singnificantly negative correlations with LVEF, and the correlation coefficients between radial and circumferential 2D-STI dyssynchrony parameters and LVEF were higher than those between the longitudinal parameters and LVEF. Conclusions 2D-STI is a useful modality to evaluate the LV systolic asynehrony of the CHF and there is a good correlation between LVEF and the LV systolic dyssynchrony indices derived from 2D-STI.

关 键 词：超声心动描记术 心力衰竭 充血性 心室功能 左 斑点追踪显像 

分 类 号：R686[医药卫生—骨科学]