组织多普勒成像技术对心脏再同步化治疗的评价  

Evaluation of cardiac resynchronization therapy by tissue Doppler imaging

作　　者：周志益[1] 任建丽[1] 张兰[1] 卢岷[1] 王志刚[1] 

机构地区：[1]重庆医科大学超声影像学研究所 重庆医科大学附属第二医院超声科,重庆市400010

出　　处：《临床超声医学杂志》2013年第6期377-380,共4页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金青年科学基金项目(81000621);教育部博士点(新教师类)基金项目(20105503120008)

摘　　要：目的探讨应用组织多普勒成像(TDI)技术评价心脏再同步化治疗(CRT)慢性心力衰竭患者的临床应用价值。方法选择拟行CRT的慢性心力衰竭患者31例,应用TDI测量收缩速度达峰时间判断左室收缩延迟部位,根据左室电极的位置是否与收缩延迟部位相符,将患者分为电极位置和收缩延迟部位符合者20例(A组)和不符合者11例(B组)。应用常规超声心动图及TDI技术观察两组术前及术后1,3,6个月左室收缩功能指标和心脏同步性参数的变化,评价CRT治疗效果。结果所有患者术前TDI技术评估均提示存在左室内收缩不同步,TDI技术能够指导左室电极植入理想靶静脉。术后1,3,6个月,患者的纽约心脏病协会心功能(NYHA)分级、6min步行距离、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、二尖瓣反流(MR)程度及室间机械延迟(IVMD)、左室12节段达峰时间标准差(Ts-SD)、左室内最晚收缩-最早收缩(Ts max-min)均较术前明显改善,术后6个月各参数改变最明显(P<0.05)。术后6个月,A,B组间NYHA分级、6min步行距离、LVEF、MR程度、IVMD、Tsmax-min及Ts-SD比较,差异均有统计学意义(均P<0.05)。结论 TDI技术可以用于慢性心力衰竭患者接受CRT的筛选,并能指导左室电极植入位置和评价疗效。Objective To explore the clinic application value of tissue Doppler imaging （TDI） in cardiac resynchronization therapy （CRT）. Methods Thirty-one patients subjected to CRT were selected. The peak time of systolic velocity was measured by TDI to determine the left ventricular delayed contraction site. According to whether left ventricular lead site being in line with left ventricular delayed contraction site, patients were divided into group A （n=20, the left ventricular lead site was in line with the delayed contraction site） and group B （n= 11, the left ventrieular lead site was not in line with the delayed contraction site ）. Left ventrieular systolic function parameters and cardiac resynchronization parameters before and after CRT were observed by conventional echocardiography and TDI, and CRT effect was assessed. Results Preoperative TDI assessment of all patients indicated the presence of left ventricular dyssynchrony. TDI can guide left ventricular lead into ideal target vein. By follow-up for 1, 3 and 6 months, NYHA grade, 6 rain walking test, LVEF, LVEDd, MR grade and IVMD, Ts max-min, Ts-SD of them were significantly improved compared with those of before CRT. Parameters change was the most remarkable six months after CRT（P〈0.05 ）. Six months after CRT,there were significant differences in NYHA grade, 6 min walking test, LVEF, MR grade and IVMD, Ts max-min, Ts-SD between group A and group B（P〈0.05 ）. Conclusion TDI can be used in selecting patients with chronic heart failure subjected to CRT, guiding left ventricular lead site and evaluating CRT effect.

关 键 词：超声心动图描记术 组织多普勒成像 心力衰竭 心脏再同步化治疗 

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