定量组织速度成像、组织同步显像与二维斑点追踪技术对心脏再同步化治疗患者术前筛选价值  

Value and feasibility study of quantitative tissue velocity imaging,tissue synchronize imaging and two-dimensional speckle tracking imaging assessment of left ventricular systolic asynchronouy in patients with cardiac resynchronization therapy

作　　者：张婧姝[1] 郑慧[1] 许继梅[1] 靳鹏[1] 解欣欣[1] 

机构地区：[1]安徽医科大学第一附属医院超声科,合肥230022

出　　处：《安徽医科大学学报》2011年第8期787-791,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省高校自然科学基金重点项目(编号:NOKJ2010A175)

摘　　要：目的探讨定量组织速度成像(QTVI)、组织同步显像(TSI)与二维斑点追踪技术(STI)对心脏再同步化治疗(CRT)术前患者左室不同步性筛选价值及不同方法之间的敏感性。方法 30例正常成人为对照组,30例心力衰竭患者为心衰组,其中心衰组中6例经CRT治疗。平静状态下获取心尖四腔切面、心尖二腔切面、左室长轴切面与左室短轴切面(二尖瓣水平、乳头肌水平、心尖水平)二维灰阶及TVI动态图像。双平面Simpson法测量左室射血分数(LVEF);脱机分析测量左室基底段和中间段12节段收缩达峰时间的标准差(Ts-12-SD)、左室16节段TSI指数、QTVI纵向收缩期达峰时间及达峰时间差、STI左室基底段、中间段及心尖段16节段纵向应变收缩期达峰时间及短轴径向收缩期达峰时间、STI纵向应变收缩期达峰时间差值及径向应变收缩期达峰时间差值。结果①心衰组的不同步数值显著高于对照组(P<0.01);心衰组术后的不同步数值显著低于术前(P<0.01)。②心衰组基底段STI左心室短轴径向应变收缩期达峰时间明显长于QTVI纵向收缩期达峰时间(P<0.01),心尖段STI左室短轴径向应变收缩期达峰时间明显长于左室纵向应变收缩期达峰时间(P<0.01);心衰组STI左室短轴径向检测出不同步节段数明显高于QTVI、TSI及STI左室长轴纵向(P<0.01)。③Ts-12-SD、TSI指数、STI纵向应变收缩期达峰时间差值、STI径向应变收缩期达峰时间差值与LVEF呈负相关性(r=-0.72、-0.57、-0.67、-0.75,P<0.05);Ts-12-SD与TSI指数、STI纵向应变收缩期达峰时间差值、STI径向应变收缩期达峰时间差值呈正相关性(r=0.93、0.95、0.97,P<0.01)。结论 QTVI、TSI、STI能较好的评价心衰患者的左室不同步性及CRT患者的短期疗效。STI短轴能更准确评价心衰患者的左室不同步性,在CRT患者术前筛选中有较大的应用价值。Objective To explore the value and feasibility study of quantitative tissue velocity imaging（QTVI）,tissue synchronize imaging（TSI） and two-dimensional speckle tracking imaging（STI）assessment of left ventricular systolic asynchronouy in patients with cardiac resynchronization therapy（CRT）.Methods Thirty normal adults were included as the control group,and thirty cases heart failure（HF） were enrolled as HF group in the study,in which six cases with CRT during one mouth.They underwent QTVI,TSI and STI.Biplane Simpson method was used to measure left ventricular ejection fraction（LVEF）.Q-lab software was used to measure the standard deviation of the time to regional peak systolic velocity（Ts）of 12 LV segments inejection phase（Ts-SD-12-ejection）,TSI index of 16 LV segments,time to peak systolic velocities（Ts）and the maximal difference in time to peak systolic velocities（Ts-maxD）QTVI long-axis,the Ts and Ts-maxD of STI long-axis and short-axis in basal segments,the middle segments and the apex segments.Results ① All the indices of systolic asynchrony were significantly larger in HF group than those in the control group and the HF group who were covered by CRT after one mouth（P0.01）.② In the basal segments,the Ts of STI short-axis radial was significantly longer than the Ts of QTVI long-axis,and the Ts of STI short-axis was significantly longer than the Ts of STI long-axis in the apex segments（P0.01）;The number of segments with asynchrony detected by STI short-axis was longer than that by STI long-axis,TVI long-axis and TSI（P0.01）.③ LVEF corrected significant negatively with that of TS-SD-12,TSI index,Ts-maxD of short-axis and long-axis（r=-0.72,-0.57,-0.67,-0.75,P0.05）.TS-SD-12 corrected significant positively with TSI index,Ts-maxD of short-axis and long-axis（r=0.93,0.95,0.97,P0.01）.Conclusion QTVI,TSI and STI can accurately assess the left ventricular systolic asynchronous in patients and the outcome of CRT.STI short-axis has a predominate and practical

关 键 词：超声心动描记术 心力衰竭/治疗 

分 类 号：R541.61[医药卫生—心血管疾病] R540.45[医药卫生—内科学]