三维斑点追踪成像技术评价慢性心力衰竭患者左心室收缩功能及收缩不同步性的价值  

Assessment of left ventricular systolic function and systolic asynchrony by three dimensional speckle-tracking imaging in patients with chronic heart failure

作　　者：周娟[1] 朱文军[1] 徐明民[1] 全丽娟[1] 

机构地区：[1]嘉兴市第一医院超声科,314000

出　　处：《浙江医学》2016年第17期1415-1418,共4页Zhejiang Medical Journal

摘　　要：目的探讨三维斑点追踪成像(3DSTI)技术评价慢性心力衰竭(CHF)患者左心室收缩功能受损程度及收缩运动不同步性的应用价值。方法 CHF患者61例,其中QRS<120ms者31例为CHF1组,QRS≥120ms者30例为CHF2组,另择同期健康体检者53例为对照组。采集一个完整心动周期的左心室三维全容积实时图像,用超声三维斑点追踪分析软件分别测量左心室面积峰值应变、径向峰值应变、圆周峰值应变、左心室纵向峰值应变(GAS、GRS、GCS、GLS)及心脏16节段心内膜面积、径向、环向、纵向峰值应变的达峰时间(Tsr3D、Tsrr、Tsrc、Tsrl),以及经心动周期标化的达峰时间的标准差(Tsr3D-SD、Tsrr-SD、Tsrc-SD、Tsrl-SD),分别计算左心室任意两节段心内膜面积、径向、环向、纵向峰值应变的达峰时间最大差值(Tsr3D-diff、Tsrr-diff、Tsrc-diff、Tsrl-diff)。结果与对照组相比,CHF1和CHF2组的GAS、GRS、GCS、GLS均较对照组降低(均P<0.05),且该值与LVEF均有较好的相关性(r=-0.857、0.758、-0.808、-0.823,均P<0.01);除了CHF1组与对照组Tsrsl-diff差异无统计学意义外,CHF1、CHF2组Tsrs3d-SD、Tsrsr-SD、Tsrsc-SD、Tsrsl-SD及Tsrs3d-diff、Tsrsr-diff、Tsrsc-diff、Tsrsl-diff均较对照组延长(均P<0.05),且与QRS时间有相关性(r=0.556、0.581、0.475、0.491、0.559、0.570、0.360、0.570,均P<0.01),CH1与CH2组各指标差异均有统计学意义(均P<0.05)。与CHF1组相比,CHF2组在心内膜面积、径向、环向、纵向收缩不同步指标均延长,差异均有统计学意义(均P<0.05)。结论 CHF患者左心室心肌收缩功能存在明显受损及收缩不同步,3D-STI为CHF患者左心室收缩功能及收缩同步性的评价提供了一种新方法。Objective To assess the left ventricular （LV） function and the motion of left ventricular wall systolic asynchrony in patients with chronic heart failure （CHF） by ultrasound three dimensional speckle-tracking imaging （3D-STI）. Methods Sixty one patients with CHF were divided into CHF1 group（QRS〈 120ms, n=31） CHF2 group （QRS ≥120ms, n=30）,53 healthy subjects served as control group. LV 3D full volumetric real-time imaging in a completed cardiac cycle were acquired. The endomyocardial area, radial, circumferential, longitudinal of the peak strain in cardia （GAS, GRS, GCS, GLS） were measured; the time from the onset of QRS complexes to peak strain rate during systole was measured from the endomyocardial area, radial, circumferential, longitudinal of 16 segments in every cardia （Tsrs3d, Tsrsr, Tsrsc, Tsrsl） using ultrasonic 3D STI software. The standard deviation of all above parameters related to heart cycle （Tsrs3d, Tsrsr, Tsrsc, Tsrsl） was calculated （Tsrs3d-SD, Tsrsr-SD, Tsrsc-SD, TsrsI-SD）, and the maximal temporal difference （Tsrs3d-diff, Tsrsr-diff, Tsrsc-diff, Tsrsl-diff）of 16 segments was also calculated as indicators of asynchrony. Results Compared with the controls, the GAS, GRS, GCS, GLS were reduced in the CHF1 and CHF2 groups （all P〈0.01） and were correlated with LVEF （r=-0.857, 0.758, -0.808,-0.823） ; the systolic asynchrony indexes （Tsas-SD, Tsrs-SD, Tscs-SD, Tsls-SD, Tsas-diff, Tsrs-diff, Tscs-diff and Tsls-diff） were significantly higher in the CHF groups （all P〈0.01）, and were correlated with QRS（r=0.556, 0.581, 0.475, 0.491, 0.559, 0.570, 0.360, 0.570）. Conclusion The LV function is damaged apparently and systolic asynchrony of LV commonly exists in patients with CHF. STI is a potentially useful tool to evaluate the systolic function and systolic asynchrony of the LV wall motion in patients with CHF.

关 键 词：三维斑点追踪 心力衰竭 左心室功能 

分 类 号：R541.6[医药卫生—心血管疾病] R445.1[医药卫生—内科学]