三维斑点追踪成像评价慢性心力衰竭左心室收缩不同步性的临床研究  

Assessment of Left Ventricular Systolic Dyssynchrony by Three-dimensional Speckle Tracking Imaging in Patients with Chronic Heart Failure

作　　者：田新桥[1] 周娟[1] 拓胜军[2] 左蕾[3] 张军[3] 刘敏[1] 刘丽文[3] 

机构地区：[1]温州医学院附属第二医院超声科,325027 [2]延安市人民医院超声诊断科,716000 [3]第四军医大学西京医院超声科,西安710032

出　　处：《医学研究杂志》2013年第6期26-29,共4页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81170305);全军后勤科研计划基金资助项目(CWS11J056)

摘　　要：目的探讨三维斑点追踪成像(3D-STI)技术评价慢性心力衰竭(CHF)患者左室收缩运动不同步性的应用价值。方法连续选择CHF患者63例以及正常对照组67例。获取两组左心室收缩末期容积(ESV)、舒张末期容积(EDV)、射血分数(LVEF)等常规指标。采集左心室实时三维全容积图像,用超声三维斑点追踪分析软件分别测量左心室16节段心内膜面积、径向、圆周、纵向应变的达峰时间(Tsas、Tsrs、Tscs、Tsls)以及标准差(Tsas-SD、Tsrs-SD、Tscs-SD、Tsls-SD),分别计算左心室任意两节段心内膜面积、径向、圆周、纵向应变的达峰时间最大差值(Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff)。结果与对照组相比,CHF组的EDV、ESV增高(P<0.01),LVEF降低(P<0.01);CHF组的Tsas-SD、Tsrs-SD、Tscs-SD、Tsls-SD及Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff)均较对照组延长(P<0.01)。结论慢性心力衰竭患者左心室心肌收缩存在明显不同步,3D-STI为评价心力衰竭患者左心室收缩功能及收缩同步性提供了一种新方法。Objective To assess the motion of left ventricular（LV） wall systolic dyssynchrony in patients with chronic heart failure （CHF） by ultrasound three - dimensional speckle tracking imaging（3D - STI）. Methods Totally 63 cases with CHF and 67 healthy sub- jects （ control group） were enrolled. L~ 3D full volumetric real - time imaging was acquired. The time from the onset of QRS complexes to peak strain during systole were measured from the endomyoeardial area, radial, circumferential and longitudinal of 16 segments in every subject respectively（Tsas, Tsrs, Tscs and Tsls）using ultrasonic 3D speckle -tracking analysis software. The standard deviation of all above parameters （ Tsas - SD, Tsrs - SD, Tscs - SD and Tsls - SD） and the maximal temporal difference （ Tsas - diff, Tsrs - diff, Tscs - diff and Tsls - diff） of 16 segments were computed as indicators of dyssynchrony. Simultaneity write down the values of left ventricular end diastolic volume （EDV） , end systolic volume （ESV） and ejection fraction （EF） were written. Results Compared with the controls, the EDV and ESV were increased（ P 〈 0. O1 ） and the LVEF was reduced（ P 〈 0.01 ） in patients with CHF. All the systolic dyssynchrony indexes（Tsas - SD, Tsrs - SD, Tscs - SD, Tsls - SD, Tsas - diff, Tsrs - diff, Tscs - diff and Tsls - diff） were significantly higher in the CHF group（all P 〈 0.01 ）. Conclusion The endomyocardial area, radial, circumferential and longitudinal systolic dyssynchrony of the LV are commonly existed in patients with CHF. 3D - STI is a potentially useful tool to evaluate the systolic dyssynchrony of the LV wall motion in patients with CHF.

关 键 词：实时三维斑点追踪成像 心力衰竭 左心室功能 

分 类 号：R541.61[医药卫生—心血管疾病]