实时三维超声心动图技术评估心衰患者左室收缩不同步的临床应用价值  

Assessment of Left Ventricular Asynchrony in Patients with Chronic Heart Failure by Real-time 3 Dimensional Echocardiography

作　　者：张跃忠[1] 郭文彬[1] 朱梅[1] 梁皓[1] 张楠[1] 冯娟[1] 郭振伟 

机构地区：[1]山东大学附属省立医院超声诊疗科,济南市250021

出　　处：《中国超声医学杂志》2009年第7期649-652,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨实时三维超声心动技术（RT3DE）评估慢性心力衰竭（心衰）患者左室收缩不同步性的临床价值。 方法选择32例慢性心衰患者和32例正常对照，应用RT-3DE和组织多普勒技术（tissue doppler imaging，TDI）分别获取两组的心尖四腔观、两腔观、左室长轴观的TDI图像和左心室的RT-3DE全容积图像，应用Qlab软件分别计算出RT-3DE全容积图像的QRS起点到16节段最小收缩容积时间标准差（Tmsv 16-SD）的百分数标准差（Tmsv 16-SD％）和TDI图像心室壁基底段和中间段12节段的收缩达峰时间（Ts）的标准差（Ts—SD）。 结果患病组的Tmsv16-SD％明显高于对照组（8．6±4．5vs1．3±1．6，P〈0．01），患病组的T16SD％与左心室射血分数（left ventricular ejection fraction，LVEF）成负相关（r=-0．89，P〈0．01）。患病组的Ts—SD明显高于对照组（31．6±5．1vs14．5±5．3，P％0．01），患病组的Ts—SD与LVEF呈负相关（r=-0．69，P〈0．01）。所有受检者Tmsv16-SD％和Ts-SD有很好的相关性（r=0．76，P〈0．01）；RT-3DE和Simpson’s双切面法测量的LVEF呈高度相关性（r=0．93，P〈0．001）。 结论RT-3DE可以定量分析心衰患者左室收缩不同步性，为心肌再同步化治疗患者的筛选提供了一种新技术。Objective To quantitatively evaluate the left ventricular systolic synchronicity in patients with chro nic heart failure by real-time three-dimensional eehoeardiography （RT-3DE）. Methods Thirty-two healthy volunteers and thirty-two patients with chronic heart failure were enrolled in this study. Full volume RT 3DE was performed using Philips IE33 with the the X3-1 matrix array 3D transducer and TDI imaging using the S5-1 2D transducer. The Tmsv 16-SD% of the end systolic time reaching minimal systolic volume for the 16 segments on volume time curves and the Ts-SD of the electromechanical coupling time for the 12 segments was measured by the Qlab software （5.0）.Results Tmsv16-SD% was markedly higher in HF patients than in controls （8. 6 ±4. 5 vs 1. 3±1. 6P〈0.01） andin creased as LVEF decreased （r= 0.89, P〈0.01） . Ts-SD was also significantly higher in HF patients （31.6 ±5. 1vs 14.5±5.3 P〈0.01） and had a good negative correlation with LVEF （r=-0.69, P〈0.01） .Tmsv16-SD%was well correlated to Ts SD （r= 0.76, P%0.01） . The LVEF determined by Simpson＇s modified biplane method correlated closely with LVEF determined by RT-3DE （r=0.93, P（0. 001） . Conclusions RT 3DE can quantify global left ventricular asynchrony RT-3DE represents a novel technique to identify chronic heart failure patients who may other wise not be considered for CRT.

关 键 词：心力衰竭 左室收缩不同步 实时三维超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R541.6[医药卫生—内科学]