组织速度成像技术评价心脏再同步化治疗患者左心室壁收缩期后收缩  

Evaluation of post-systolic shortening in the patient with cardiac resynchronization therapy using quantitative ultrasonic tissue velocity imaging

作　　者：李金芳[1] 张军[1] 刘丽文[1] 张海滨[1] 刘兵[2] 易甫[2] 李雪[1] 温江田[1] 

机构地区：[1]第四军医大学西京医院超声科,西安710032 [2]第四军医大学西京医院心内科,西安710032

出　　处：《中华医学超声杂志（电子版）》2009年第2期24-27,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：西京医院临床高新技术基金资助(2008LCGX-13)

摘　　要：目的探讨心力衰竭患者心脏再同步化治疗(CRT)前后左心室壁收缩期后收缩(PSS)变化对评价室壁运动同步性的价值。方法对15例慢性心力衰竭患者CRT术前、术后3个月和正常对照组21例,应用Philips IE33型彩色超声诊断仪,分别获取受检者心尖3个标准切面的心肌组织速度图像,并用Q-Lab分析软件测量左心室壁基底部和中间部12个节段收缩达峰时间的标准差(Ts-SD)、射血期峰值速度(Vs)、PSS峰值速度(Vpss),计算Vpss与Vs的比值(Vpss/Vs),并对数据行统计学分析。结果(1)正常对照组仅少数节段出现生理性PSS,多位于室间隔及前壁的基底部,Vpss/Vs<1;慢性心力衰竭组多数节段出现病理性PSS,15例患者中有55个节段出现Vpss/Vs>1;(2)CRT患者术后3个月基底部及中间部的Vs明显高于术前(P<0.01),基底部Vpss明显低于术前(P<0.01),左心室基底部Vpss/Vs明显低于术前(P<0.01),中间部Vpss/Vs较术前无明显改善;(3)CRT患者术后3个月左心室舒张末内径(LVEDD)、左心室舒张末容积(LVEDV)及左心室收缩末容积(LVESV)均较术前明显减小,左心室射血分数(LVEF)较术前明显增大(P<0.01)。结论左心室壁PSS在慢性心力衰竭患者CRT前后室壁同步化运动评估中具有一定的临床意义。CRT能够明显改善慢性心力衰竭患者的心肌收缩功能,逆转左心室解剖重构。Objective To explore the effect of post-systolic shortening （PSS） in assessing left ven- tricular asynchrony of cardiac resynchronization therapy （CRT）. Methods A total of fifteen patients with advanced chronic heart failure at baseline and three months after CRT and 21 non-cardiac disease subjects （control group） were studied. The Philips IE33 was used to examine tissue velocity imaging on 3 standard apical chamber images of each patient. The Q-LAB system was used to analyze the standard deviation of the time to regional peak systolic velocity in ejection phase （Ts-SD） , the peak velocities during systolic phases （ Vs ） and the peak velocities of PSS （ Vpss ） at 12 segments of basal and middle left ventricular wall. The ratio of Vpss and Vs was calculated. The Student＇ s t-test or nonparametric test was used to compare the differ- ence of parameters in the 2 groups. Results The physiologic PSS was only detected at minority segments in normal control group, such as the basal segments of anterior wall or interventricular septum, and Vpss/Vs 〈 1. But the pathologic PSS in heart failure patients was observed and Vpss〉 1 in 55 segments of the 15 patients. The Vs in different segments of left ventricular regional myocardium in CRT group after three months was higher than that of at baseline, and Vpss in basal segments three months after CRT was lower than that of before CRT. The ratio of Vpss and Vs in basal segments was recovered significantly after CRT, but there was no significant difference in the middle segments even though they recovered. The echocardiographic parameters, such as left ventricular end-diastolic diameter （LVEDD） , left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV） were lower and left ventricular ejection fraction （LVEF） was higher in those at three months after CRT than those at baseline. Conclusions The PSS is helpful for assessment of left ventricular asynchrony of CRT. The CRT can contribute to the LV systoli

关 键 词：超声心动描记术 充血性心力衰竭 心室复建 左心室功能 

分 类 号：R541.6[医药卫生—心血管疾病]