实时三维超声评价心肌梗死后左心室收缩功能及室壁运动同步性  

Assessment of left ventricular systolic function and synchrony in patients after myocardial infarction by real-time three-dimensional echocardiography

作　　者：田雨[1] 姜志荣[1] 吕启凤[1] 王小凡[1] 

机构地区：[1]青岛大学附属医院心脏超声科,山东青岛266000

出　　处：《中国医学影像技术》2015年第4期541-545,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨实时三维超声心动图(RT-3DE)评价心肌梗死患者左心室收缩功能及同步性的应用价值。方法选取67例心肌梗死患者(心梗组)及61名健康志愿者(正常组)分别接受RT-3DE、M型超声及二维超声检查,心梗组分为3个亚组,A亚组:左冠状动脉狭窄(n=19)、B亚组:右冠状动脉狭窄(n=28),C亚组:多支病变(n=20)。分析比较3种方法所测以下参数:左心室整体、局部舒张末期容积(gEDV、rEDV),整体、局部收缩末期容积(gESV、rESV),整体、局部射血分数(gEF、rEF);左心室16节段从QRS波起点到最小收缩容积时间的标准差和最大差值(Tmsvl6-SD、Tmsvl6-Dif)。结果 M型超声、Simpson法所测的gEDV、gESV均高于RT-3DE(P均<0.05)。以gEF<55%作为判断收缩功能降低的截断点,M型超声、Simpson法、RT-3DE诊断心肌梗死的敏感度与特异度分别为96%和43%、98%和52%、98%和64%。RT-3DE局部心功能分析:与正常组对应节段比较,A亚组主要为前壁、前间隔,B亚组侧壁、下后壁、后间隔,C亚组绝大多数节段EDV、ESV增加,EF降低(P均<0.05)。心梗组Tmsvl6-SD、Tmsvl6-Dif、Tmsvl6-SD%、Tmsvl6-Dif%均大于正常组(P均<0.05)。结论 RT-3DE能更客观、准确地评价心肌梗死患者的收缩功能及室壁运动同步性,且能逐个节段进行局部定量分析,为临床提供更加全面可靠的参考信息。Objective To explore the value of real-time three-dimensional echocardiography（RT-3DE）in evaluation of the left ventricular systolic function and motion synchronization in patients with myocardial infarction（MI）.Methods Totally 61 cases of healthy volunteers（normal group）and 67 patients with MI（MI group）underwent the RT-3DE,M-mode and two-dimensional echocardiography.The patients with MI were divided into three subgroups,i.e.left coronary artery stenosis（Subgroup A,n=19）,right coronary artery stenosis（Subgroup B,n=28）,multivessel lesions（Subgroup C,n=20）.The correlations and difference of the parameters measured by RT-3DE,M-mode and two-dimensional echocardiography were analyzed,including global and regional end-diastolic volume（gEDV,rEDV）,global and regional end-systolic volume（gESV,rESV）,global and regional ejection fraction（gEF,rEF）and the time to minimal systolic volume of 16-segmental＇standard deviation and mixmal difference（Tmsv16-SD,Tmsv16-Dif）.Results The gEDV,gESV estimated by RT-3DE was lower than that of M-mode and two-dimensional echocardiography（all P〈0.05）,Taking the EF55% as the cut-off value of systolic function abate,ROC curve analysis demonstrated a sensitivity of 96%,a specificity of 43%for M-mode,sensitivity of 98%,specificity of 52%for Simpson method,sensitivity of 98%,specificity of 64%for RT-3DE.RT-3DE could undertake the analysis of regional cardiac function,Subgroup A showed systolic function abate in segments mainly of anterior wall and anteroseptum,Subgroup B were in inferior wall and posterior wall,most segments of Subgroup C had the systolic function abate（all P〈0.05）.The parameters of wall motion synchronization（Tmsvl6-SD,Tmsvl6-Dif,Tmsvl6-SD%,Tmsvl6-Dif%）in MI group were all higher than that of normal group（all P〈0.05）.Conclusion RT-3DE can more objectively and accurately evaluate the systolic function and wall motion synchronization in patients with MI,and it can provide regional analysis to offer more comprehensiv

关 键 词：实时三维超声心动图 心肌梗死 心室功能 左 收缩功能 同步性 

分 类 号：R540.45[医药卫生—心血管疾病] R542.22[医药卫生—内科学]