应用2D-STI与RT-3DE评价类风湿性关节炎患者左心室收缩同步性

目的 探讨二维斑点追踪成像技术（2D-STI）和实时三维超声心动图（RT-3DE）评价不同病程活动期类风湿性关节炎（RA）患者左心室收缩同步性的临床应用价值，以及这两种方法在评价左心室收缩同步性方面的相关性。方法 收集90例活动期RA患者，根据病程将RA患者分为三组，每组30例：A组病程1-5年；B组病程5-10年；C组病程>10年，同时选取30例健康志愿者作为对照组。受试者均行常规超声心动图、2D-STI、RT-3DE检查，应用QLAB10.4定量分析软件进行分析，获得同步性参数：左室纵向应变及环向应变达峰时间标准差（Tls-SD、Tcs-SD），左室16节段的标准差（Tmsv-16-SD）及最大时间差（Tmsv-16-Dif）、经R-R间期校正后的左心室16节段达到最小收缩容积的时间的标准差占心动周期的百分比（Tmsv-16-SD%）及最大差占心动周期的百分比（Tmsv-16-Dif%）。结果 A、B、C三组与对照组比较，Tmsv-16-SD、Tmsv-16-Dif、Tmsv-16-SD%、Tmsv-16-Dif%逐渐延长,差异有统计学意义（P<0.05），B、C两组与对照组比较，Tls-SD、Tcs-SD延长，差异有统计学意义（P<0.05）。同步性参数Tls-SD、Tcs-SD分别与Tmsv-16-SD、Tmsv-16-Dif呈正相关。组内相关系数（ICC）分析显示,2D-STI与RT-3DE两种技术对左室同步性指标的测量具有较好的一致性。结论 随着患病时间的增加，RA患者左心室同步性指标逐渐延长，引起左心室收缩不同步，2D-STI和RT-3DE较常规超声心动图能更早的检测出RA患者左心室同步性的变化，均可定量评价左心室收缩同步性，且一致性较好。

The synchronization of left ventricular contraction in patients with rheumatoid arthritis was evaluated by 2D-STI and RT-3DE

Objective to investigate the clinical value of 2D spot tracking imaging (2D-STI) and real-time 3D echocardiography (RT-3DE) in evaluating left ventricular systolic synchronization in patients with active rheumatoid arthritis (RA) of different disease courses, and the correlation between the two methods in evaluating left ventricular systolic synchronization. Methods 90 patients with active RA were collected and divided into three groups according to the course of disease. The course of disease in group B was 5-10 years. The disease course of group C was more than 10 years and 30 healthy volunteers were selected as the control group. All subjects underwent routine echocardiography, 2D-STI, RT-3DE examination, and were analyzed by QLAB10.4 quantitative analysis software to obtain synchronization parameters: left ventricular longitudinal strain and circumferential strain reaching peak time standard deviation (Tls-SD, Tcs-SD), left ventricular 16-segment standard deviation (Tmsv-16-SD) and maximum time difference (Tmsv-16-Dif),the percentage of standard deviation (Tmsv-16-SD%) and the percentage of maximum difference (Tmsv-16-Dif%) of the time for the 16 segments of the left ventricle to reach the minimum systolic volume after R-R interval correction. Results Tmsv-16-SD, Tmsv-16-Dif, Tmsv-16-SD% and Tmsv-16-Dif% were gradually prolonged in group A, B and C compared with the control group, and the differences were statistically significant (P<0.05). Tls-SD and Tcs-SD were prolonged in group B and C compared with the control group, and the differences were statistically significant (P<0.05). The synchronization parameters Tls-SD and Tcs-SD were positively correlated with Tmsv-16-SD and Tmsv-16-Dif, respectively. The Intra-group correlation coefficient (ICC) analysis showed that 2D-STI and RT-3DE had good consistency in measuring left ventricular synchronization. Conclusion with the increase of the duration of disease, the left ventricular synchrony index of RA patients gradually lengthened, causing the left ventricular systolic dyssynchrony. Compared with conventional echocardiography, 2D-STI and RT-3DE could detect the changes of left ventricular synchrony in RA patients earlier, both of which could quantitatively evaluate the left ventricular systolic synchrony with good consistency.