三维斑点追踪成像技术预测心脏再同步化治疗短期疗效的研究

目的探讨三维斑点追踪成像（3DT）技术评价左心室收缩同步性，预测心脏再同步化治疗（CRT）短期疗效的临床价值。方法接受CRT治疗的心力衰竭患者18例，于CRT术前及术后1个月用常规超声测量左心室舒张末期容积（LVEDV）、收缩末期容积（LVESV）及射血分数（LVEF）。采用3DT技术分析左心室16节段面积应变达峰时间最大差（A—Max-Ts）和标准差（A—Ts—sD）。将术后LVESV缩小≥15％定义为CRT短期治疗有效。18例患者中，CRT短期治疗有效组11例，CRT短期治疗无效组7例。结果与术前比较，有效组术后LVEDV和LVESV减小，LVEF增高，A—Max—Ts和A-Ts-SD缩短（P〈0．05）；无效组各参数比较差异均无统计学意义。有效组术前A—Max—Ts和A—Ts-SD大于无效组（P〈0．05），其余参数比较差异均无统计学意义。有效组术后LVEDV和LVESV较无效组减小，LVEF增高，A—Max—Ts和A—Ts-SD缩短（P〈0．05）。A—Ts—SD是预测LVESV≥15％的独立因素，A—Ts-SD为48．2ms时预测CRT短期疗效的敏感性和特异性分别为100％和83．3％。结论CRT短期即可改善左心室收缩同步性。3DT技术能准确评价左心室收缩同步性，预测CRT短期疗效。

Prediction of short-term response to cardiac resynchronization therapy by three-dimensional speckle tracking imaging

Objective To evaluate the value of three-dimensional speckle tracking（3DT） in predicting short-term response to cardiac resynchronization therapy （CRT） in clinic. Methods Eighteen patients with congestive heart failure received the CRT,their left ventricular end-diastolic volume （LVEDV）, left ventrieular volume （LVESV） and left ventricular ejection fraction （LVEF） were measured by conventional ultrasonography before and one month after CRT operation. The response time to peak of the area in 16 left ventricular segments were analyzed by 3DT technology. The maximum differential （A-Max-Ts） and standard deviation （A-Ts-SD） were then calculated. Patients were divided into responders and non- responders based on a reduction over 15% in LVESV after CRT. Among 18 patients, 11 of them were responders,7 of them were non-responders. Results Compared with non-responders, the responders demonstrated a significant increase of LVEF and reduction of A-Max-Ts and A-Ts-SD （P 〈 0.05 ）.A-Ts-SD was a determinant to predicted LVESV reduction over 15%. When the A-Ts-SD was 48.2 ms, the sensitivity and specificity to predict the short-term reponse were 100% and 83.3%,respectively. Conclusion The CRT could significantly improve cardiac function and synchrony soon.3DT could be used to predict the short- term response to CRT in clinic.