超声二维斑点追踪显像技术评价慢性心力衰竭患者左心室运动同步性的初步临床研究

目的 探讨超声二维斑点追踪成像(two dimensional speckle-tracking imaging.2D-STI)技术评价慢性心力衰竭(chronic heart failure.CHF)患者左心室运动同步性的应用价值.方法 CHF患者37例,其中QRS≤120 ms者22例(CHF1组),QRS＞120 ms者15例(CHF2组);正常对照组30例.心尖长轴及胸骨旁短轴观上描记受试者左室壁运动的应变率曲线.于心尖长轴、胸骨旁短轴观分别测量心电图QRS波起始点至各节段纵向、径向及环向收缩期应越变率达峰时间(Tsrsl、Tsrsr、Tsrsc)以及舒张早期应变率达峰时间(Tsrel,Tsrer、Tsrec),计算左室整体在纵向、径向、环向的达峰时间标准差(Tsrsl-SI)、Tsrel-SD、Tsrsr-SD、Tsrer-SD、Tsrsc-SD、Tsrec-SD)及任意两节段最大达峰时间差值(Tsrsl-diff、Tsrel-diff、Tsrsr-diff、Tsrer-diff、Tsrsc-diff、Tsrec-diff).结果与对照组相比较,CHF1及CHF2组左心室收缩不同步指标Tsrsl-SD、Tsrsr-SD、Tsrsc-SD及Tsrsl-diff、Tsrsr-diff、Tsrsc-diff.舒张不同步指标Tsrel-SD、Tsrer-SD,Tsrec-SD及Tsrel-diff、Tsrer-diff、Tsrec-diff均显著延长,差异具有统计学意义(P＜0.05).CHF1与CHF2组间在径向、环向舒张不同步指标(Tsrer-SD、Tsrer-diff,Tsrec-SD、Tsrec-diff)差异具有统计学意义.结论 CHF患者的芹窜心肌在纵向、径向及环向上收缩及舒张存在显著不同步性,其与QRS间期无关.2D-STI为评价慢性心力衰竭患者左室心肌收缩及舒张运动同步性提供了一种新方法.

Assessment of left ventricular motion asynchrony in patients with chronic heart failure by ultrasound two dimensional speckle-tracking imaging

Objective To assess the motion asynchrony of left ventricle(L V)wall in patients with chronic heart failure(CHF)by ultrasound two dimensional speckle-tracking imaging(2D-STI).Methods Thirty-seventy patients with CHF were divided into two groups:CHF1 group,22 with QRS≤120 ms;CHF2 group,15 with QRS ＞120 ms.Thirty healthy subjects(control group)were enrolled.2D-STI was applied to display and analyze the strain rate imaging on the three standard LV apical views and parasternal LV short-aix views,respectively.The time from the onset of QRS complexes to peak strain rate during systole(Tsrs)and early-diastole(Tsre)were measured from the longitudinal,radial and circumferential vector respectively(Tsrsl,Tsrel,Tsrsr.Tsrer,Tsrsc,Tsrec).The standard deviation of all above parameters(Tsrsl-SD.Tsrel-SD,Tsrsr SD,Tsrer-SD,Tsrsc-SI).Tsrec-SD)and the maximal temporal difference(Tsrsl-diff.Tsrel-diff,Tsrsr-diff,Tsrer-diff,Tsrsc-diff,Tsrec-diff)of 18 segments were calculated as indicator of dyssynchrony.Results The systolic dyssynehrony indices Tsrsl-SD,Tsrsl-diff,Tsrsr-SD,Tsrsr-diff,Tsrsc-SD Tsrsc-diff and diastolic dyssynchrony indices Tsrel-SD,Tsrel-diff,Tsrer-SD,Tsrer-diff,Tsrec-SD,Tsrec-diff were significantly higher in the CHF1 and CHF2 group than those in the control group(all P＜0.05).Compared with the values in the CHF1 group,the systolic indices of dyssynchrony and the radial and circumferential diastolic indicator of dyssynchrony in CHF2 group were longer(P＜0.05).Conclusions The longitudinal,radial and circumferential systolic and diastolic dyssynchrony of the LV were commonly existed in patients with CHF,regardless of QRS duration.2D-STI is a potientially useful tool to evaluate the systolic and diastolic synchrony of the LV wall motion in patients with CHF.