组织多普勒和应变/应变率显像评价心力衰竭患者心脏再同步化治疗

目的评价超声心动图组织多普勒和应变/应变率在心力衰竭患者心脏再同步化治疗（cardiac resyn-chronization therapy,CRT）中的应用价值。方法34例患者植入双室起搏器后随机进行4种不同模式起搏（双腔起搏BiV,左室起搏LV,右室起搏RV和不起搏即窦性心律状态）。行常规超声心动图及二维彩色组织多普勒（doppler tissue imaging,DTI）检查,测量射血分数（LVEF）、每搏输出量（SV）、每个节段的心肌收缩速度峰值、节段心肌收缩位移、应变及应变率和每个节段心电图QRS波起始至该节段收缩达峰时间（Ts）。并比较不同基础疾病导致的心力衰竭起搏后的改善情况。结果LV和BiV能够提高每搏输出量（P均〈0.02）和射血分数（P均〈0.001）;左室节段心肌收缩位移LV时明显改善;LV心尖段室间隔以及侧壁收缩期应变率和应变均改善;但是,BiV只有侧壁心尖段应变率明显改善。不同基础疾病起搏后心功能的改变差别没有统计学意义。结论LV和BiV可明显改善心力衰竭患者的心功能。超声心动图DTI、应变/应变率可以无创伤性评价CRT治疗效果,并随访预后。

Evaluation of ventricular synchrony using doppler tissue imaging and strain/strain rate in patients with heart failure receiving cardiac resynchronization therapy

Purpose To assess the value of doppler tissure imaging and strain/strain rate in patients with heart failure receiving cardiac resychronization therapy. Methods A biventricular(BiV) pacemaker was implanted in 34 patients with heart failure.Two-dimensional standard and Doppler tissue echocardiography was performed during right ventricular(RV),left ventricular(LV),BiV,and no pacing in a random and blinded manner.Left ventricular ejection fraction(EF),stroke volume(SV),systolic peak myocardial velocities,segmental myocardial systolic displacement,strain/strain rate,and regional Q-wave-to-peak systolic displacement times(Ts) were measured and the impact of different underlying disease was evaluated. Results LV and BiV pacing increased SV(P<0.02,for both) and LVEF(P<0.001 for both).Segmental myocardial systolic displacement was significantly improved during LV pacing.Systolic strain rate and strain improved in the apical segment of septal and lateral walls during LV pacing.Strain rate was only improved significantly during BiV pacing in the apical segment of the lateral wall.No significant difference was found between patients with ischemia and non-ischemia. Conclusions LV and BiV pacing provide benefits for patients with heart failure.Doppler tissue imaging and strain/strain rate are useful noninvasive tools for assess CRT.