全方向M型超声评价右心室流出道起源室性期前收缩患者左心室运动同步性  

Evaluation of left ventricular synchronicity in patients with premature ventricular beats from right ventricular outflow tract by omni-directional M-mode echocardiography

作　　者：郭薇[1] 赖宝春[2] 

机构地区：[1]福建省立医院心血管病研究所,福州350001 [2]福建医科大学省立临床学院

出　　处：《中华医学超声杂志（电子版）》2011年第2期16-19,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：卫生部科学研究基金-福建省卫生教育联合攻关项目(WKJ2005-2-010)

摘　　要：目的探讨全方向M型超声心动图评价右心室流出道(RVOT)起源室性期前收缩(PVB)患者左心室心肌径向运动同步性的临床价值。方法对30例右心室流出道起源PVB患者(PVB组)和30例健康志愿者(对照组),应用全方向M型超声系统测量左心室短轴乳头肌水平6个节段收缩期速度达峰时间(Ts)及舒张早期速度达峰时间(Td),计算6个节段的标准时间差(Ts-6-SD,Td-6-SD),以评价PVB对左心室运动同步性的影响。结果在所有节段中,PVB组正常窦性心律时Ts、Td与对照组比较,差异无统计学意义(P>0.05),而Ts-6-SD、Td-6-SD均大于对照组(P<0.05),PVB组PVB时的Ts、Td、Ts-6-SD、Td-6-SD均大于正常窦性心律时(P<0.01)。结论右心室流出道起源PVB患者在窦性心律及PVB时左心室收缩与舒张均存在失同步,全方向M型超声能够为评价左心室心肌径向运动同步性提供一定的参考价值。Objective To explore a new method to evaluate myocardial viability with quantitative tissue velocity imaging （QTVI） and tissue tracking （TT） combined with adenosine stress echocardiography. Methods The peak systolic velocity （Vs）,isovolumic contraction peak velocity （Vivc） and the maximum systolic displacement （Ds） of each segment were detected using TT with QTVI in 36 cases of elderly patients with myocardial infarction at rest and adenosine （140 μg·kg-1·min-1） was administered for 6 minutes. Every segment was defined as viable or non-viable myocardium according to radionuclide myocardial perfusion / metabolic imaging. Then the sensitivity and specificity of assessment of viable myocardium with QTVI and TT combined with adenosine stress were studied by echocardiography. Results There was no significant difference in Vs,Vivc and Ds at rest between viable group and non-viable myocardial group. Although Vivc had no significant change （P0.05）,Vs and Ds were increased （P0.05） after adenosine administration in viable group while no significant change in all variables was found in non-viable group（P0.05）. From the ROC curve,the cut-off value of △Vs（%）≥16.5 after adenosine by echocardiography had a high sensitivity （92.8%） and specificity （78.8%） in identifying viable myocardium. △Ds （%）≥18.5 after adenosine by echocardiography had a better sensitivity （91.1%） and specificity （76.9%） in identifying viable myocardium. Combining these two indicators to detect myocardial viability,the sensitivity and specificity were 89.3% and 88.5%,respectively. Conclusion The QTVI and TT combined with adenosine by echocardiography could provide a reliable and new method for identifying viable myocardium.

关 键 词：超声心动描记术 左心室功能 室性期前收缩 同步性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.7[医药卫生—诊断学]