斑点追踪成像评估扩张型心肌病伴碎裂QRS波患者心室同步性及心功能的变化  

The Changes of Ventricular Synchrony and Cardiac Function in Dilated Cardiomyopathy Patients with Fragmented QRS Complexes

作　　者：陆娟[1] 钱大钧[1] 戴敏[1] 沈伟刚[1] 邵墨沁[1] 曹云翔[1] 王如兴[1] 

机构地区：[1]南京医科大学附属无锡市人民医院心脏中心,江苏省无锡市214023

出　　处：《中国超声医学杂志》2014年第4期336-341,共6页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨扩张型心肌病(DCM)伴碎裂QRS(f-QRS)波患者心室同步性及心功能的变化。方法采用斑点追踪成像(STI)技术对20例DCM伴f-QRS波患者(f-QRS组)和29例DCM伴正常QRS(n-QRS)波患者(n-QRS组)进行研究。分别测量两组左心室(左室)各节段纵向、径向和环向应变达峰时间及左室收缩期整体纵向、径向和环向应变;计算各节段达峰时间标准差及各节段达峰时间最大差值。以左室短轴观乳头肌水平前间隔和后壁的径向应变达峰时间差130ms或纵向应变延迟指数25%作为左室不同步标准。比较f-QRS组和n-QRS组室内不同步参数与心功能参数及随访2年后上述参数的变化。结果 f-QRS组有15例(75%)存在室内不同步,n-QRS组有5例(17%%)存在室内不同步(P<0.01)。在随访2年期间,f-QRS组2例猝死,n-QRS组无猝死(P<0.05);随访2年后f-QRS组室内不同步加重(P<0.05),n-QRS组无明显变化(P>0.05);f-QRS组和n-QRS组心功能参数入选研究时无差别(P>0.05),随访2年后,f-QRS组患者心功能较n-QRS组明显降低(P<0.05)。结论 f-QRS波可作为评估DCM患者室内不同步和预后判断的可靠指标,STI技术可准确测定f-QRS波患者心室同步性及心功能的变化。Objective To investigate the changes of ventricular synchrony and cardiac function of dilated cardio- myopathy （DCM） patients with fragmented QRS （f-QRS） complexes. Methods 20 DCM patients with f-QRS com- plexes and 29 DCM patients with normal QRS （n-QRS） complexes were studied by speckle tracking imaging （ST/）, the patients were categorized into f-QRS group and n-QRS group. The left ventricular （LV） segmental longitudinal, radial and circumferential time to peak strain and general longitudinal systolic strain, radial strain, circumferential strain were measured respectively. The LV segmental standard deviation and maximal difference were calculated. The LV dyssynchrony was defined as the time in peak anteroseptal wall to posterior wall radial strain 130 ms or longitudi- nal strain delay index 25%. Parameter changes of ventricular dyssynehrony and cardiac function in f-QRS grouo and nQRS group were compared when patients were enrolled and followed up after 2 years. Results In f-ORS group, there were 15 patients （75%） with significant LV dyssynchrony. However, there were only 5 patients （17%） with signifi- cant LV dyssynchrony in n-QRS group （P（O. 01 ）. 2 patients died of sudden death in f-QRS group during 2 years fol- low up. However, no patients died in n QRS group （P〈0.05）. The intraventricular dyssynchrony in f-QRS group was aggravated after 2 years follow-up （P〈0. 05）. However, there was no significant change in n-QRS group （P〈 0.05）. Cardiac functions in two groups were almost similar when enrolled （P〉0.05）, but the parameters of cardiac function obviously got worsen in f-QRS group, compared with those in n-QRS group after 2 years follow up （P〈0.05）. Conclusions f-QRS can be used as a reliable index to evaluate ventricular dyssynchrony and predict prognosis of the patients with DCM. Changes of ventricular dyssynchrony and cardiac function in DCM patients with f-QRS can be accurately assessed by ST1.

关 键 词：碎裂QRS波 扩张型心肌病 室内不同步 心功能 斑点追踪成像 

分 类 号：R542.2[医药卫生—心血管疾病]