二维斑点追踪成像技术评价完全性左束支传导阻滞患者的左心室功能及同步性

目的应用二维斑点追踪成像技术（2D-STI）探讨不同应变模式对完全性左束支传导阻滞（CLBBB）患者左心室收缩功能及同步性的影响。 方法选取2016年4月至2018年4月在中国医科大学附属第一医院接受检查的CLBBB患者90例，根据二维纵向应变特征分为经典型（CPD）组及非CPD型（n-CPD）组，再进一步选取其中左心室射血分数（LVEF）>50%的患者，同上分为CPD组及n-CPD组；另选30名健康人作为健康对照组。对各组均行常规超声心动图及2D-STI检查，测量常规超声心动图参数：左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）及LVEF等；测量并计算左心室整体纵向峰值应变（GLS）、左心室流出道与右心室流出道射血前期时间差（IVMD）、基底段和中间段左心室侧壁与室间隔的应变达峰时间延迟（b-Ssl，m-Ssl）以及左心室18节段心肌纵向应变达峰时间的标准差（SDt）。 结果与健康对照组比较，CPD组及n-CPD组LAD、RVBD、E/e′增高，E/A、EDT减低，差异均有统计学意义（t=5.12、3.67、7.29、5.69、5.89、3.15、2.05、5.89、5.22、3.83，P均<0.01）；与n-CPD组比较，CPD组LAD、E/e′增高，E/A减低，差异均有统计学意义（t=8.12、3.24、3.94，P均<0.01）。与健康对照组比较，CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高，LVEF、左心室间隔、侧壁及总体纵向应变减低，差异均有统计学意义（t=20.38、7.17、7.35、6.50、5.86、10.24、7.15、6.35、11.24、10.99、5.92、6.12，P均<0.001）；与健康对照组比较，n-CPD组QRS、LVEDD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高，LVEF、左心室间隔、侧壁及总体纵向应变减低，差异均有统计学意义（t=16.54、1.99、2.12、2.07、5.87、2.53、2.10、5.06、2.68、3.66、2.06、3.62，P均<0.05）；与n-CPD组比较，CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高，LVEF、左心室间隔、侧壁及总体纵向应变减低，差异均有统计学意义（t=4.68、5.96、6.63、5.32、5.01、5.10、5.28、4.86、7.16、4.74、7.20、3.78、3.57，P均<0.001）。进一步选择LVEF>50%的患者进行比较，组间LVEF比较，差异无统计学意义（P>0.05），与健康对照组比较，CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高，左心室间隔、侧壁及总体纵向应变减低，差异均有统计学意义（t=19.44、4.01、5.21、5.61、4.73、9.19、5.27、3.16、3.25、8.02、4.15、5.42，P均<0.001）；与健康对照组比较，n-CPD组QRS、LVEDD、LVEDV、LVESV、IVMD、b-Ssl、m-Ssl、SDt增高，左心室间隔及总体纵向应变减低，差异均有统计学意义（t=20.68、2.46、3.15、3.10、6.95、3.00、4.59、6.53、3.84、4.05，P均<0.05）；与n-CPD组比较，CPD组QRS、LVEDD、LVESD、LVEDV、LVESV、IVMD、b-Ssl、SDt增高，左心室间隔、侧壁及总体纵向应变减低，差异均有统计学意义（t=2.73、2.13、3.88、3.06、2.19、3.94、3.00、3.25、4.38、2.90、2.30，P均<0.05）。 结论常规超声心动图结合2D-STI技术可早期发现CLBBB患者左心室收缩功能及收缩同步性减低，且CPD型CLBBB较n-CPD型CLBBB进一步减低的现象，可提示临床需密切关注CPD型CLBBB患者，及时进行治疗干预。

Value of two-dimensional speckle tracking imaging in assessing left ventricular function and synchrony in patients with complete left bundle branch block

ObjectiveTo explore the effect of different strain patterns on left ventricular systolic function and synchrony in complete left bundle branch block (CLBBB) patients using two-dimensional speckle tracking imaging (2D-STI). MethodsNinety patients with CLBBB were included from April 2016 to April 2018. The patients with CLBBB were divided into two groups based on the criteria of classic pattern of dyssynchrony (CPD) and non-classic pattern of dyssynchrony (n-CPD). Furthermore, patients with left ventricular ejection fraction (LVEF)> 50% were further selected and divided into a CPD group and n-CPD group as above. Thirty healthy subjects were included as controls. Common echocardiography and 2D-STI were performed. Left ventricular end-diastolic dimension and volume (LVEDD and LVEDV) as well as left ventricular ejection fraction (LVEF) were measured. Global left ventricular longitudinal strain (GLS), interventricular mechanical delay time (IVMD), basal-segment strain septal to lateral strain peak time delay (b-Ssl), mid-segment septal to lateral strain peak time delay (m-Ssl), and standard deviation of time to longitudinal strain peak for the left ventricular 18 segments (SDt) were measured and calculated. ResultsLAD, RVBD, E/e′, LVEDD, and LVEDV values in the CPD and n-CPD groups were significantly higher than those in the control group, and E/A and EDT in the CPD and n-CPD groups were significantly lower than those in the control group (t=5.12, 3.67, 7.29, 5.69, 5.89, 3.15, 2.05, 5.89, 5.22, and 3.83, P<0.01). Compared with the n-CPD group, LAD and E/e′ values were significantly higher and E/A was significantly lower in the CPD group (t=8.12, 3.24, and 3.94, respectively, P<0.001). Compared with the healthy control group, QRS, LVEDD, LVESD, LVEDV, LVESV, IVMD, b-Ssl, m-Ssl, and SDt values were significantly higher and LVEF, Sept-LS, Lat-LS, and GLS values were significantly lower (t=20.38, 7.17, 7.35, 6.50, 5.86, 10.24, 7.15, 6.35, 11.24, 10.99, 5.92, and 6.12, respectively; P<0.001) in the CPD group; QRS, LVEDD, LVESD, LVEDV, LVESV, IVMD, b-Ssl, m-Ssl, and SDt values were significantly higher and LVEF, Sept-LS, Lat-LS, and GLS values were significantly lower (t=16.54, 1.99, 2.12, 2.07, 5.87, 2.53, 2.10, 5.06, 2.68, 3.66, 2.06, and 3.62, respectively, P<0.05) in the n-CPD group. Compared with the n-CPD group, QRS, LVEDD, LVESD, LVEDV, LVESV, IVMD, b-Ssl, m-Ssl, and SDt values were significantly higher and LVEF, Sept-LS, Lat-LS, and GLS values were significantly lower (t=4.68, 5.96, 6.63, 5.32, 5.01, 5.10, 5.28, 4.86, 7.16, 4.74, 7.20, 3.78, and 3.57, respectively, P<0.001) in the CPD group. Further, patients with LVEF > 50% were selected for comparisons, and there was no significant difference in LVEF between the two groups (P>0.05). Compared with the healthy control group, QRS, LVEDD, LVESD, LVEDV, LVESV, IVMD, b-Ssl, m-Ssl, and SDt values were significantly higher and Sept-LS, Lat-LS, and GLS values were significantly lower (t=19.44, 4.01, 5.21, 5.61, 4.73, 9.19, 5.27, 3.16, 3.25, 8.02, 4.15, and 5.42, respectively, P<0.001) in the CPD group; QRS, LVEDD, LVEDV, LVESV, IVMD, b-Ssl, m-Ssl, and SDt values were significantly higher and Sept-LS and GLS values were significantly lower (t=20.68, 2.46, 3.15, 3.10, 6.95, 3.00, 4.59, 6.53, 3.84, and 4.05, respectively, P<0.05) in the n-CPD group. Compared with the n-CPD group, QRS, LVEDD, LVESD, LVEDV, LVESV, IVMD, b-Ssl, and SDt values in CPD group were significantly higher and Sept-LS, Lat- LS, and GLS values were significantly lower (t=2.73, 2.13, 3.88, 3.06, 2.19, 3.94, 3.00, 3.25, 4.38, 2.90, and 2.30, respectively, P<0.05l) in the CPD group. ConclusionConventional echocardiography combined with 2D-STI technology can early detect reduced systolic function and systolic synchronicity of the left ventricle in CLBBB patients, as well as the phenomenon that the systolic function and systolic synchronicity are further decreased in typical CLBBB compared with non-typical CLBBB, which can prompt clinical attention to typical CLBBB patients and timely treatment intervention.