三维斑点追踪技术对慢性心力衰竭患者心脏再同步化治疗短期疗效的评价  

Evaluation of the short-term efficacy of cardiac resynchronization therapy by three-dimensional speckle tracking imaging

作　　者：纳丽莎[1] 高文霞[2] 刘丽文[3] 拓胜军[4] 左蕾[3] 张军[3] 

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部,银川750004 [2]宁夏医科大学研究生学院 [3]第四军医大学西京医院超声诊断科 [4]陕西省延安市人民医院超声诊断科

出　　处：《中华超声影像学杂志》2013年第10期838-842,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81170305）;2012年陕西省社发攻关科技计划项目（2012K15-02-03）

摘　　要：目的 应用超声心动图三维斑点追踪成像（3D-STI）技术评价慢性心力衰竭（CHF）患者心脏再同步化治疗（CRT）后的短期疗效.方法 接受CRT的CHF患者27例,分别于术前及术后应用3D-STI进行分析,获取左室16节段平均面积、纵向、环向、径向应变峰值（MAS、MLS、MCS、MRS）等收缩功能参数,获取左室16节段面积、环向、纵向、径向应变达峰时间标准差（TAS-SD、TCS-SD、TLS-SD、TRS-SD）以及左室16节段面积、环向、纵向、径向应变达峰时间最大差值（TAS-dif、TCS-dif、TLS-dif、TRS-dif）等不同步参数,获取左室基底部、心尖部的旋转角度峰值、整体扭转角度峰值（RotA、RotB、Twist）及三者的达峰时间（PTRotA、PTRotB、PTtw）等扭转参数,比较术前及术后3个月上述参数之间的差异,并将术后3个月各参数的变化值与术后3个月Simpson双平面法所测左室射血分数（LVEF）的变化值（△LVEF）进行相关性分析.结果 与术前相比,CRT术后3个月MAS、MCS、MLS、MRS、RotA、Twist均增加（P＜0.01,P＜0.05,P＜0.01,P＜0.01,P＜0.01,P＜0.01）,TRS-SD、PTtw均减小（P＜0.01,P＜0.05）;MAS、MLS、RotA、Twist的变化值｜△MAS｜、｜△MLS｜、△RotA、△Twist与术后3个月△LVEF具有相关性（r=0.521,P=0.005;r =0.389,P=0.045;r =0.513,P=0.006;r =0.610,P=0.001）;TRS-SD的减小值△TRS-SD与术后3个月△LVEF具有相关性（r=-0.560,P=0.002）.结论 CRT后短期内左室心肌在不同矢量方向上收缩期的形变能力（即收缩功能）明显改善,同步性明显改善,扭转功能明显增强.3D-STI为CRT短期疗效的评价提供了新的方法.Objective To evaluate the short-term efficacy of cardiac resynchronization therapy（CRT）by three-dimensional speckle tracking imaging （3D-STI）.Methods 27 chronic heart failure patients who underwent CRT were enrolled.All following indices were measured respectively：the left ventricular systolic function indices in the 16 segments of 3D-STI including the mean area peak strain,the mean longitudinal peak strain,the mean circumferential peak strain,and the mean radial peak strain（MAS,MLS,MCS,MRS） ; the strain-derived dyssynchrony indices in the 16 segments of 3D-STI including the standard deviation for time to peak area strain,the standard deviation for time to peak longitudinal strain,the standard deviation for time to peak circumferential strain,and the standard deviation for time to peak radial strain （TAS-SD,TCS-SD,TLS-SD,TRS-SD） ;the standard deviation for time to peak area strain,the standard deviation for time to peak circumferential strain,the standard deviation for time to peak longitudinal strain,and the standard deviation for time to peak radial strain（TAS-dif,TCS-dif,TLS-dif,TRS-dif） ;the rotation and twist index of 3D-STI including peak rotation on apical plane,peak rotation on basal plane,peak twist angle（RotA,RotB,Twist）,time to peak of the rotation on apical,time to peak of the rotation on bastal,time to peak of the twist （PTRotA,PTRotB,PTtw）.The differences of all the indices between before CRT and 3 months after CRT were calculated and the correlation between the changes of all those indices and the changes of left ventricular ejection fraction （△LVEF） were analyzed.Results MAS,MLS,MCS,MRS,RotA and Twist were increased 3 months after CRT （P ＜0.01,P ＜0.05,P ＜0.01,P ＜0.01,P＜ 0.01,P ＜0.01）;TRS-SD and PTtw was decreased 3 months after CRT （P ＜0.01,P ＜0.05） ; ｜△MAS｜,｜ △MLS｜,△TRSSD,△RotA and △Twist were correlated with △LVEF 3 months after CRT （r =0.521,P =0.005; r =0.389,P =0.045; r =-0.560,P =0.002; r =0.513,P =0.006; r =0.

关 键 词：超声心动描记术 三维 心力衰竭 充血性 心脏再同步化治疗 斑点追踪显像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学]