二维斑点追踪检测的左心室扭转预测心脏再同步化治疗的短期疗效  

Prediction of Short-term Response to Cardiac Resynchronization Therapy by Left Ventricular Twist Using Two-dimensional Speckle Tracking Echocardiography

作　　者：马春燕[1] 张旖骁[2] 刘爽[1] 程艳彬[1] 杨军[1] 于波[3] 张立敏[1] 唐力[1] 陈昕[1] 

机构地区：[1]中国医科大学附属第一医院心血管超声科,沈阳110001 [2]中国医科大学第94期临床医学七年制,沈阳110001 [3]中国医科大学附属第一医院心内科,沈阳110001

出　　处：《中国医科大学学报》2011年第10期919-921,924,共4页Journal of China Medical University

基　　金：辽宁省自然科学基金资助项目(20102280)

摘　　要：目的探讨超声二维斑点追踪(STE)检测的左心室扭转参数预测心脏再同步化治疗(CRT)短期疗效的价值。方法接受CRT治疗的心衰患者34例,在术前3 d及术后1个月采用STE检测左心室基底和心尖峰值旋转角度(Rot-Ba和Rot-Ap)、基底和心尖达峰值旋转角度时间(T-Ba和T-Ap)、基底和心尖达峰时间差(Ba-Ap Rot Delay)、左心室峰值扭转角度(Ptw)和达峰时间(TPtw)、左心室标化峰值扭转角度(Ptor)。将术后左室收缩末容积(LVESV)减小率ΔLVESV≥15%定义为CRT短期治疗有效。结果 21例(61.8%)患者为CRT短期治疗有效组(R组)。术前R组Rot-Ba、Rot-Ap、Ptw和Ptor大于无效组(NR组),Ba-ApRot Delay短于NR组,其余参数无差异。术后与NR组比较,R组的Rot-Ba、Rot-Ap、Ptw和Ptor增大,Ba-Ap Rot Delay缩短。Rot-Ap、Ptw和Ptor是ΔLVESV≥15%的独立影响因素,Ptw>2.2°预测CRT短期治疗有效的敏感性和特异性分别为78%和74%。结论 STE检测的左心室扭转参数可准确预测CRT短期疗效。Objective To evaluate the value of left ventricular （LV） twist assessed by two-dimensional speckle-tracking echocardiography （STE） in predicting the short-term response to cardiac resynchronization therapy （CRT）. Methods 34 heart failure patients scheduled for CRT were included. STE was performed before and one month after the pacemaker implantation to assess the LV peak apical and basal rotation degrees （Rot-Ap and Rot-Ba）, time intervals between apical and basal rotations （Ba-Ap Rot Delay）, peak twist （Ptw）, and peak torsion （Ptor）. Patients were divided into responders and non-responders,based on a reduction I〉 15% in LV end-systolic volume （LVESV） after CRT. Results 21 patients （61.8%） were classified as responders. Compared with non-responders,the responders demonstrated a significant increase of LV ejection fraction,Rot-Ap,Rot-Ba,Ptw,and Ptor,and shortening of Ba-Ap Rot Delay. Rot-Ap,Ptw and Ptor were the determinants of ALVESV 〉t 15% ,and a Ptw〉2.2° prognosticated short-term response to CRT with 78% sensitivity and 74% specificity. Conclusion LV twist is highly predictive for short-term response to CRT, and STE is a reliable technique for evaluating LV twist.

关 键 词：二维斑点追踪 左心室扭转 心脏再同步化治疗 短期疗效 

分 类 号：R540[医药卫生—心血管疾病]