组织同步显像技术在扩张型心肌病心脏同步化治疗的临床应用

目的 探讨常规超声心动图及组织同步显像（TSI）技术在扩张型心肌病心脏同步化治疗（CRT）前、后的临床应用价值.方法 53例CRT治疗的扩张型心肌病患者,于CRT术前3d、术后1周、3个月和6个月在超声心动图指导下进行个体化参数程控,观察CRT前后不同起搏参数时各指标变化.结果 CRT治疗后左心室发生逆重构,其中术后3个月及6个月左心室舒张末期内径、左心室舒张末期容积明显小于术前（P＜0.01,P＜0.05）,左心室舒张充盈时间增加,二尖瓣反流量减少,LVEF明显提高（P＜0.01）,重度延迟节段数减少,节段数量由术前的3.1±1.3减少至6个月的1.5±1.4（P ＜0.01）,左心室起搏电极所在节段的达峰时间有的回复到正常范围,收缩峰值速度亦有改善,但仍没有到正常水平,12节段达峰时间标准差（Ts-SD）由术前的（139±33）ms缩短至（110±40）ms,差异有统计学意义（P＜o.01）.结论 常规超声心动图和TSI技术是预测评价CRT疗效的临床应用最简便有效的方法,是参与CRT全程的一种无创、准确的检查手段.

Clinical application of tissue synchronization imaging in dilated cardiomyopathy cardiac resynchronization therapy

Objective To investigate the clinical application of conventional echocardiography and tissue synchronization imaging（TSI） technique in dilated cardiomyopathy cardiac resynchronization therapy（CRT） before and after.Methods The study included 53 dilated cardiomyopathy patients who underwent CRT treatment,in the three days prior to the implantation of CRT pacemaker and 1 week,3 months and 6 months after it,programmed individual parameters in echocardiography monitoring and observed the changes in various indicators before and after CRT pacing parameters.Results In patients with dilated cardiomyopathy after CRT the left ventricular reverse remodeling occurred 3 months and 6 monthsafter the therapy,the left ventricular end diastolic diameter and volume were significantly smaller than that before the therapy（P ＜0.01,P ＜0.05）,the left ventricular diastolic filling time increased,the mitral regurgitation reduced,the left ventricular contractility increased,LVEF significantly improved（P＜0.01）,and the number of the severe delay segments gradually reduced,the number of delay segments from preoperative（3.1 ± 1.3） decreased to（1.5 ± 1.4） after 6 months（P ＜ 0.01）,the standard deviation of 12 segments time to peak decreased from（139 ± 33） msto（110 ± 40） ms（P ＜ 0.01）.Conclusions After the individual optimal setting with pacing parameters and order,and the longitudinal study,the atrioventricular,interventricular and intraventricular synchrony in patients with CRT were greatostly improved.Currently the conventional echocardingraphy and tissue synchronization imaging technology are the most effective and simplist methods to forecast and evaluate the clinical application of CRT,and also the noninvasive,accurate means involved in the whole process of the CRT.