实时三平面组织同步显像技术在心脏再同步化治疗中的应用价值  

Application of tissue synchronization imaging by real-time thriplane echocardiography in cardiac resynchronization therapy

作　　者：魏常华[1] 王一洒[1] 朱好辉[1] 陈纪昀[1] 高帆[1] 屈雪蒸 袁建军[1] 

机构地区：[1]郑州大学人民医院(河南省人民医院)超声科,450003

出　　处：《中华超声影像学杂志》2015年第7期553-557,共5页Chinese Journal of Ultrasonography

基　　金：国家卫生计生委2013-2014年度国家临床重点专科建设项目资助

摘　　要：目的探讨实时三平面组织同步显像（（RT3PE—TSI）技术在心脏再同步化治疗（CRT）中的临床应用价值。方法对24例拟行CRT的心力衰竭患者，在治疗前和CRT术后1个月优化治疗前及优化治疗后2个月分别行超声心动图检查，24例健康志愿者作为对照组。常规测量左室舒张末内径（LVIDd）、收缩末内径（LVIDs）、左室射血分数（LVEF）及左室流出道血流速度时间积分（VTILVOT）等。应用RT3PE-TSI技术测量左室壁基底段和中间段12个心肌节段的局部收缩达峰时间（Tp）、12节段收缩达峰时间的最大差值（12-Tp—DIF）和标准差（12-Tp—SD），确定室壁运动最延迟的心室壁节段，并依此指导起搏电极的放置位置；CRT术后1个月在超声心动图指导下行起搏器AV和VV间期优化。结果在治疗前、治疗后、优化后和对照组，LVIDd、Tp、LVIDs、12-Tp—DIF和12-Tp—SD均依次降低，LVEF、VTILVOT依次增高，组间差异均有统计学意义（P〈O．05）。TSI显示术前24例患者均存在左室内收缩不同步，最延迟收缩部位位于侧壁8例，下壁10例，后壁6例。左室起搏电极植入位置与收缩最延迟部位一致。相关性研究显示12-Tp—DIF和12-Tp—SD与LVEF具有良好的相关性（r分别为-0．70，-0．73，P=0．000）。结论RT3PE—TSI能够直观、准确地定量评价左室心肌运动的同步性，对CRT术前患者的筛选、指导左室电极的放置位置及起搏程序的优化等方面具有重要的临床指导意义和应用价值。Objective To investigate the applicable value of tissue synchronization imaging （TSI） by real-time thriplane echocardiography （RT3PE） in cardiac resynchronization therapy （CRT）. Methods Twenty-four patients with heart failure scheduled for CRT and 24 healthy controls were enrolled. Two dimensional echocardiography was performed to get the left ventricular internal diameter at end-diastole and end-systole（LVIDd, LVIDs）, left ventricular ejection fraction （LVEF）, velocity time integral of left ventricular outflow tract flow（VTILvoT）. The RT3PE TSI was performed to measure the time to peak systolic velocities（Tp） of left ventricle basal and middle segments（12 segments） ,software will automatically calculate the maximal difierence （12-Tp-DIF） and standard deviation（12-Tp-SD） of Tp in 12 segment. Identity the segment where wall motion most delay and to guide electrode placement. AV and VV interval optimization were performed under guidance of TSI after 1 month of CRT. Results In before CRT,after CRT, after optimization and control group, LVIDd, Tp, LVIDs, 12-Tp-DIF and 12-Tp-SD were decreased in the order,LVEF and VTILvoT were increased in the order. There were significant difference between the groups（all P ~0.05）. TSI showed that left ventricular systolic dyssynchrony was present in all patients before CRT. The most delay segment and electrode location was consistent. There were close correlation between 12-Tp-DIF and LVEF （r = -0.70, P = 0.000）,between 12-Tp-SD and LVEF（ r = -0.73, P = 0.000）. Conclusions Left ventricular systolic synchronicity can be evaluated accurately and intuitively using TSI by RT3PE. It has important clinical significance in prospectively select patients for CRT, help to guide electrode placement and to optimize device programming.

关 键 词：超声心动描记术 实时三平面 组织同步显像 心力衰竭 心脏再同步疗法 

分 类 号：R541.6[医药卫生—心血管疾病] R540.45[医药卫生—内科学]