应用二维斑点追踪技术对完全性左束支传导阻滞患者左心室的功能及其同步性的评价  

Evaluation of the Effect of Complete Left Bundle Branch Block on Left Ventricular Function and Mechanical Dyssynchrony by Two-dimensional Speckle Tracking Imaging

作　　者：张艳娟 许迪 姚静[2] 吴红平[2] 谢冰 

机构地区：[1]南京医科大学第一附属医院老年心血管科,南京市210029 [2]南京医科大学第一附属医院心脏科,南京市210029

出　　处：《中国超声医学杂志》2012年第8期702-704,共3页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.81000618);江苏省属高校自然科学研究基金(No.10KJD320001)

摘　　要：目的运用二维斑点追踪技术(two dimensional speckle tracking imaging,2D-STI)评价正常人、孤立性完全性左束支传导阻滞(complete left bundle branch block,CLBBB)患者以及合并有心力衰竭的CLBBB患者左心室的收缩功能和机械同步性,并进一步分析心脏的收缩功能和机械同步性之间的关系。方法选取孤立性CLBBB患者29例(CLBBB1),合并有心力衰竭的CLBBB患者20例(CLBBB2),正常对照组16例:采用双平面Simpson法测量左室射血分数(LVEF),2D-STI技术测量左心室整体纵向应变值(GLPS-Avg)以及18节段纵向应变达峰时间,从而计算出左心室18节段应变达峰时间标准差(Ts-SD)。结果 (1)与正常组比较,CLBBB1组GLPS-Avg降低(P<0.05),Ts SD延长(P<0.01);(2)与正常组和CLBBB1组比较,CLBBB2组LVEF、GLPS-Avg明显降低(P<0.000),Ts-SD明显延长(P<0.000);(3)LVEF与GLPS-Avg均反映左心室的收缩功能,二者具有良好的相关性。结论左室射血分数在正常范围内的孤立性CLBBB患者,左室整体纵向应变值降低,左心室内同步性轻度受损,而合并有心力衰竭的CLBBB患者左室收缩功能明显降低,左心室内明显不同步。Objective To evaluate the global left ventrieular （LV） systolic function and mechanical dyssynchrony by two-dimensional speckle tracking imaging （2D-STI） in healthy volunteers, isolated complete left bundle branch block （CLBBB） patients and CLBBB patients with heart failure（HF）. At the same time, the relationship between LV systolic function and mechanic dyssynchrony was investigated. Methods Total 60 patients involved 16 healthy volunteers, 29 patients with asymptomatic CLBBB and 20 CLBBB patients with HF. Simpson method was used to measure left ventricular ejection fraction （LVEF）. 2D-STI was performed to measure average global longitudinal strain （GLPS- Avg） and time to peak longitudinal strain of eighteen segments （Ts-SD-18）. Results LVEF and GLPS-Avg of CLBBB patients with HF were significantly different （P〈0. 000） compared with the healthy volunteers. These two parameters were also significantly different （P〈0.05） between asymptomatic LBBB and HF＋LBBB. To compared with iso lated CLBBB and healthy volunteers, Ts-SD-18 was significantly higher in CLBBB patients with HF. On the other hand, Ts-SD-]8 was also higher in isolated CLBBB compared with healthy volunteers. Conclusions Isolated CLBBB patients had more depressed LV systolic function than healthy volunteers had, even though their LVEF were in the normal range. And CLBBB patients with HF had severe LV systolic function. Compared with healthy volunteers, isolated CLBBB patients had an intermediate mechanical dyssynchrony, and CLBBB patients with HF had the most severe mechanical dyssynchrony.

关 键 词：二维斑点追踪 左束支传导阻滞 左心室功能 同步性 

分 类 号：R541.7[医药卫生—心血管疾病] R445.1[医药卫生—内科学]