实时三维超声心动图对冠状动脉狭窄患者左室收缩同步性与功能的研究

目的探讨实时三维超声心动图（RT-3DE）对冠状动脉左前降支（LAD）不同程度狭窄患者左室收缩同步性与收缩功能的研究。方法经冠状动脉造影证实LAD狭窄患者90例，据狭窄程度分成：Ⅰ组47例，狭窄率50％-75％；Ⅱ组43例，狭窄率76％。95％。正常对照组35例，LAD无狭窄。所有患者行RT-3DE检查，获得同步性参数指标：左室16节段、12节段、6节段达到最小收缩容积的时间标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）、最大时间差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）及各自径心动周期的校正值（Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％）和左室节段收缩功能参数：节段性舒张末期容积（rEDv）、收缩末期容积（rEsV）、射血分数（rEF），比较三组间上述参数。结果Ⅱ组患者Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％与对照组、Ⅰ组比较，均显著延迟，LAD供应节段rEDV、rESV均增大，rEF均降低，差异均有统计学意义（均P〈0．05）；Ⅰ组患者各参数指标与对照组比较差异无统计学意义。结论RT-3DE能定量评价LAD狭窄76％～95％患者左室收缩的非同步性及缺血节段局部收缩功能的减低。

Evaluation of left ventricular systolic synchrony and function in patients with coronary artery stenosis by real-time three-dimensional echocardiography

Objective To evaluate left ventricular systolic synchrony and function in patients with different degrees of left anterior descending（LAD） coronary artery stenosis by real-time three-dimensional echocardiography（RT-3DE）. Methods Ninety patients with different degrees of LAD stenosis were divided into 2 groups acording to angiocardiography：group Ⅰincluding 47 patients with 50%-75% coronary artery stenosis,group Ⅱ including 43 patients with 76%~95% coronary artery stenosis. Thirty-five subjects were in control groups with no coronary artery stenosis. All patients were measured by RT-3DE.The synchrony parameters, such as the time-volume curves parameters in 16 segments, 12 segments and 6 segments （Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD;Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif）, the correction value by cardiac cycle of respective parameters （Tmsv 16-SD%, Tmsv 12-SD% ,Tmsv 6-SD% ,Tmsv 16-Dif% ,Tmsv 12-Dif% ,Tmsv 6-Dif% ）, and the systolic function parameters egional end-diastolic volume （rEDV）, end-systolic volume （ rESV ） and ejection fraction （rEF） were required. The parameters were compared between the groups. Results Compared with group I and control group, the parameters of Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif% in group Ⅱ were delayed significantly（P〈0.05）. The rEDV and rESV end-systolic and diastolic volume of the segments supplied by LAD were incresed significantly, and rEF was deeresedobviously. The parameters between group Ⅰandcontrolgrouphadnosignificantdifference（P〉O.05） Conclusion RT-3DE can quantitatively assess left ventricular dyssynchrony and systolic function decrease of isehemia segment in patients with 76%- 95% LAD stenosis.