实时三维超声心动图容积-时间曲线评价心脏再同步化术后左心室舒张早期同步性  

Assessment of the left ventricular early diastolic synchrony of cardiac resynchronization therapy by real time echocardiographic volume-time curves in patients with dilated cardiomyopathy

作　　者：刘海兰[1] 叶雪存[1] 崔亮[1] 王卫真[1] 袁高乐[2] 

机构地区：[1]江西省人民医院超声科,南昌330006 [2]南昌大学第一附属医院儿科

出　　处：《中华超声影像学杂志》2014年第3期194-198,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用实时三维超声心动图（RT-3DE）容积-时间曲线评价扩张型心肌病（DCM）患者心脏同步化（CRT）术后左室舒张功能及舒张早期同步性变化以及二者间的关系。方法对39例DCM患者于术前及术后1周、6个月、12个月行RT-3DE检查，分析其容积-时间曲线，得出左心室16、12、6节段达舒张早期容积的时间标准差（Tedv-SD），用R—R间期标准化后，作为舒张早期不同步化指数（DDI），得出左室收缩末容积（LVESV）、舒张末容积（LVEDV）、射血分数（LVEF），并计算出舒张期峰值充盈率（PFR）、舒张期早期容积与舒张末期容积之比（EDV早／EDV）。结果与CRT术前比较：术后1周LVEDV、LVESV无明显改善，而术后6个月及12个月明显改善（P〈0．05，P〈0．01）；LVEF术后明显改善（P〈0．05）；术后6个月PFR增加（P〈0．05），EDV4／EDV于术后12个月显著减小（P〈0．01）。各节段（Tedv-SD）／R-R术后1周显著缩短（P〈0．01）。相关分析：CRT术前后ADDI与AEDV早／EDV减少呈显著正相关（r=0．52，P〈0．01），与APFR呈负相关（r=-0．40，P〈0．05），△XEDV早／EDV与APFR之间也有良好的相关性（r=-0．56，P〈0．01）。结论DCM患者CRT术后左室同步性及舒张功能均得到改善，PFR、EDVP／EDV可作为评价左室舒张功能的有效指标。Objective To evaluate the diastolic function and relationship between diastolic function and early diastolic synchrony in patients with dilated cardiomyopathy （DCM） by real-time three-dimensional echocardiography （RT-3DE） volume-time curves （VTC） after cardiac resynchronization therapy （CRT）. Methods Thirty-nine patients with DCM were enrolled by RT-3DE VTC before and 1 week,6 months, 12 months after CRT, draw the left ventricular （LV） 16,12,6 segments LV diastolic early volume standard deviation of the time （Tedv-SD）,and with the R-R interval normalized as early diastolic unsynchronized index （DDI） ;draw end-systolic volume （LVESV）, LV end-diastolic volume （LVEDV）, LV ejection fraction （LVEF）;and calculate the diastolic peak filling rate（PFR）, the ratio of early diastolic volume and enddiastolic volume（EDVearly/EDV）. Results LVEDV, LVESV had no significant improvement. Compared with the before and 1 week after CRT,but the improvement was statistically significant after 6 months and 12 months （P 〈0.05, P〈0.01）; LVEF after 1 week, 6 months and 12 months were statistically significant （ P 〈0. 05） ;Compared with before, PFR after 6 months was significantly increased （ P 〈0.05）, EDVearly/EDV at 12 months after CRT was significantly reduced （P 〈 0.01）, There was a significantly shortened in each segment （Tedv-SD）/R-R 1 week after CRT （P 〈0.01）, but the parameters had no obvious improvement later. Correlation analysis.. A DDI and A EDVearly/EDV reduction was significant positive correlation （ r = 0.52, P 〈0.01）, ADDI and PFR has negative correlation （ r = - 0.40, P 〈 0.05） ,A EDVearly/EDV and APFR also had a good relationship （ r = - 0.56, P 〈0.01）. Conclusions The LV synchrony and diastolic function were improved after CRT in patients with DCM; PFR,EDVearly/EDV can be used as evaluation of left ventricular diastolic function effectively targets.

关 键 词：超声心动描记术 实时三维 心肌病 扩张型 心脏再同步疗法 心室功能 左 

分 类 号：R445.1[医药卫生—影像医学与核医学]