实时三维斑点追踪技术评价完全性左束支传导阻滞患者左心室收缩功能  

Evaluation of left ventricular systolic function in patients with complete left bundle branch block by real-time three-dimensional speckle tracking

作　　者：何姗姗 赵宁 张文华[2] HE Shanshan;ZHAO Ning;ZHANG Wenhua(Department of Ultrasound,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029,China;Department of Ultrasound,the Second Hospital of Dalian Medical University)

机构地区：[1]南京中医药大学附属医院超声医学科,南京210029 [2]大连医科大学附属第二医院超声医学科

出　　处：《临床心血管病杂志》2019年第12期1109-1114,共6页Journal of Clinical Cardiology

摘　　要：目的:应用实时三维斑点追踪技术对完全性左束支传导阻滞(CLBBB)患者左心室整体及局部收缩功能进行评价。方法:选取孤立性CLBBB患者35例,根据左心室射血分数(LVEF)将其分为A组(LVEF≥50%,18例)和B组(LVEF<50%,17例)。另选取30例健康成年人为对照组。采集各组二维超声数据,采用Simpson法测定LVEF。记录并比较各组三维斑点追踪技术测量的三维应变数据:左心室整体纵向收缩期峰值应变(LVGLS)、左心室整体环向收缩期峰值应变(LVGCS)、左心室整体径向收缩期峰值应变(LVGRS)、左心室整体面积收缩期峰值应变(LVGAS),以及各组间左心室心肌基底段、中间段及心尖段三维应变值。采用ROC曲线分析各三维应变参数诊断CLBBB合并心功能减低的敏感性和特异性。结果:与对照组比较,A组与B组LVGLS、LVGRS、LVGCS、LVGAS均减低,差异有统计学意义(均P<0.05);与A组比较,B组LVGLS、LVGRS、LVGCS及LVGAS均减低,差异有统计学意义(均P<0.05)。各组左心室基底段、中间段、心尖段局部三维心肌应变数值均呈递减改变,差异均具有统计学意义(均P<0.05)。ROC曲线分析结果显示,各参数诊断CLBBB合并心功能减低的曲线下面积为0.805~0.910,准确性较好,其中LVGLS的敏感性(96.4%)及特异性(76.7%)高于其他应变参数。结论:CLBBB患者左心室心肌不协调运动,主要以前壁及前间隔的改变为主;左心室不协调运动导致左心室整体及局部心肌功能减低。实时三维斑点追踪技术可以早期、敏感、准确地评价CLBBB患者的左心功能,其中LVGLS更为敏感。Objective:To evaluate the global and regional left ventricle systolic function in patients with complete left bundle branch block(CLBBB) by real-time three-dimensional spot tracking technique.Method:Thirty-five cases with isolated CLBBB were divided into two groups according to left ventricular ejection fraction(LVEF):group A(LVEF≥50%,n=18)and group B(LVEF<50%,n=17).Other 30 healthy adults were included into control group.Two-dimensional ultrasonic parameters were measured.LVEF was tested by Simpson method.Real-time three-dimensional echocardiography were used to determine following parameters in three groups:left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular global radial strain(LVGRS),left ventricular global area strain(LVGAS),and threedimensional strain values of the basal,middle and apical segments of left ventricular myocardium.ROC curve was used to analyze the sensitivity and specificity of three-dimensional strain parameters in the diagnosis of CLBBB with cardiac dysfunction.Result:Compared with control group,LVGLS,LVGRS,LVGCS,and LVGAS were significantly decreased in group A and group B(all P<0.05);Compared with group A,LVGLS,LVGRS,LVGCS and LVGAS were significantly decreased in group B(all P<0.05).All three-dimensional strain values of the basal,middle and apical segments of left ventricular myocardium were decreased successively with significant differences(all P<0.05).ROC curve analysis showed that the area under the curve of three-dimensional strain parameters in the diagnosis of CLBBB with cardiac dysfunction were 0.805-0.910,and the accuracy was good.The sensitivity(96.4%)and specificity(76.7%)of LVGLS were higher than other strain parameters.Conclusion:The left ventricular myocardial motion is not coordinated in CLBBB patients,mainly including antetheca and front interval changes,which result in the global and regional myocardial dyfunction of left ventricular.Three-dimensional speckle tracking can be used to evaluate left ven

关 键 词：实时三维斑点追踪技术 完全性左束支传导阻滞 室性心律失常 左心功能 

分 类 号：R541.7[医药卫生—心血管疾病]