实时三维超声心动图和超声斑点追踪技术评价扩张型心肌病左心室收缩同步性

目的 利用实时三维超声心动图(RT-3DE)和超声斑点追踪技术(STI)评价正常人和扩张型心肌病(DCM)患者左心室收缩同步性.方法 选取27例DCM患者(DCM组)与29名正常人(对照组)的标准心尖位左室流出道切面,四腔心切面,两腔心切面及实时三维经胸超声心动图,得到左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左心室射血分数(LVEF)、心电图Q波起始点距离16节段和12节段最小容积点时间间隔的标准差(Tmsv16-SD、Tmsv12-SD)及其最大差(Tmsv16-Dif、Tmsv-12Dif).用STI分别测量其左心室心肌各节段心电图Q波起始点到组织速率收缩峰值(Ts-SD)、应变率收缩峰值时间的标准差(Tsr-SD).结果 DCM组左心室心肌的组织速率、应变率及RT-3DE的容积-时间曲线交错紊乱,同步性差;DCM组Tmsv16-SD、Tmsv12-SD、Tmsv16-Dif、Tmsv-12Dif、Ts-SD、Tsr-SD与对照组相比差异有统计学意义(P均<0.05).结论 RT-3DE 和 STI两种方法 均能够评价左心室心肌收缩同步性.STI是通过检测多个心动周期,而RT-3DE则是在同一心动周期检测,更加快速、简便、准确.

RT-3DE and STI evaluation of left ventricular myocardial systolic synchrony in patients with dilated cardiomyopathy

Objective To evaluate left ventricular myocardial systolic synchrony in patients with dilated cardiomyopathy (DCM) with real-time three-dimensional echocardiography (RT-3DE) and speckle tracking imaging (STI). Methods Twenty-seven patients with DCM (DCM group) and 29 healthy subjects (control group) were studied at apical four-chamber, two-chamber view, apical longitudinal views and full volume RT-3DE. The LVEDV, LVESV, LVEF were derived from RT-3DE. The systolic dyssynchrony parameters derived from RT-3DE included the dispersion of time to minimum regional volume for 16 and 12 left ventricular segments (Tmsv16-SD and Tmsv12-SD) and the maximum difference of time to minimum regional volume for 16 and 12 left ventricular segments (Tmsv16-Dif and Tmsv12-Dif). STI dyssynchrony indexes included the standard deviation of time to peak systolic velocity (Ts-SD) and peak strain rate (Tsr-SD). Results Velocity, rate of strain and volume-time curve of myocardium of left ventricle were in disordered arrangement in DCM group, while well-ordered in the control group. Compared with control group, all parameters in DCM were statistically higher (P<0.05). Conclusion Both RT-3DE and STI can evaluate left ventricular systolic dyssynchrony. STI is tested through a number of cardiac cycles, whereas RT-3DE is tested in the same cardiac cycle, so it is a quick, convenient and exact technique.