实时三维超声心动图评价心力衰竭患者QRS波宽度与左室收缩同步性研究  

Assessment of left ventricular dyssynchrony in patients with different duration of QRS by real-time three-dimensional echocardiography

作　　者：杨凤[1] 张新书[1] 姜凡[1] 解翔[1] 陈万林[1] 

机构地区：[1]安徽医科大学第二附属医院超声诊断科,合肥230601

出　　处：《安徽医科大学学报》2011年第7期689-692,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的应用实时三维超声心动图(RT-3DE)分析研究慢性心力衰竭(简称心衰)患者QRS波宽度与左室收缩同步性关系。方法对30例健康志愿者(A组)及75例各种原因导致的心衰患者(B组)行RT-3DE检查。将B组依据QRS波宽度分为B1、B2、B3组,分别获取A、B各组左室射血分数(LVEF)、左室舒张末期容积(EDV)、左室收缩末期容积(ESV)及左室16节段达到收缩末最小容积时间的标准差(SDI),将5.12%作为截点值,判断左室收缩同步与否。结果①A组左室心肌收缩均同步,运动曲线呈均匀的反抛物线,达峰时间一致;B组心肌收缩不同步,达峰时间长短不一,运动曲线杂乱无章。②A、B各组在年龄和心率上差异无统计学意义(P>0.05);A、B各组在LVEF、EDV、ESV、SDI上差异有统计学意义(P<0.05);B1、B2、B3组在LVEF、EDV、ESV、SDI上差异有统计学意义(P<0.05)。③B1、B2、B3组中分别有17、18、16例患者心肌收缩不同步,即窄QRS波中有心肌收缩不同步,宽QRS波中有心肌收缩同步情况。结论心衰患者QRS波越宽左室收缩不同步性越高,RT-3DE可评估不同宽度QRS波心肌收缩同步性及指导临床实施心脏再同步化(CRT)治疗。Objective To use real-time three-dimensionanl echoacrdiography（RT-3DE） to examine the left ventricular（LV） systolic synchrony in patients with heart failure（HF）.Methods Group A consisted of 30 nomal volunteers.Group B consisted of 75 patients of HF which was divided into B1,B2,B3 on the basis of QRS width（B1：QRS120 ms;B2： 120 ms≤QRS 150 ms;B3： QRS≥150 ms）.They were analyzed and compared by RT-3DE,all of them had the time of 16 segmentsation of the LV.Calculation of the systolic dyssynchrony index（SDI） was to compare the standard deviation of the time each of 16 regions to reach its minimal volume and to analyze the LV systolic synchrony.Using the mean of SDI 5.12% as the marker of LV′s dyssynchrony.Results ① Group A′s LV systolic curves were regular and anti-parabola,they had the same time to minimal volume.Group B′s LV systlic curves were irregular and in a great mess,they had different time to minimal volume.② Group A,B had no statistical significance in ages and heart rates（P0.05）.The LVEF,EDV and ESV in group A were lower than those in group B（P0.05）.The LVEF,EDV and ESV in group B1 were lower than those in group B2,B3.The LVEF,EDV and ESV in group B2 were lower than those in group B3（P0.05）.③ LV systolic dyssynchrony was observed in group B1（17/30）,B2（18/25）and B3（16/20）.Conclusion HF patients have higher systolic dyssynchrony in wider QRS duration.RT-3DE is a utility method to assess the LV systolic synchrony in different duration QRS and provide a efficient technique to considere the clinic for CRT.

关 键 词：心力衰竭/超声检查 

分 类 号：R541.6[医药卫生—心血管疾病] R445.1[医药卫生—内科学]