实时三维超声心动图评价左心功能不全患者左心室收缩同步性

目的：探讨实时三维超声心动图在左心功能不全患者左心室收缩同步性中的临床价值。方法：正常对照组31例；左心功能不全组患者96例，根据左室射血分数（LVEF）分为轻度（30例）、中度（34例）和重度（32例）左心功能不全组，根据心电图QRS波宽度分为宽QRS（64例）和窄QRS（32例）左心功能不全组，对所有研究对象的RT-3DE容积-时间曲线进行分析，以对照组Tmsv16-SD%的均数+3个标准差，作为左室收缩期不同步化指数（SDI）的截点值。结果：①正常对照组，轻、中、重度左心功能不全组收缩期不同步化指数（SDI）分别为1.54%±0.85%、2.71%±4.52%、5.56%±2.22%、7.88%±1.67%，轻度左心功能不全组与正常对照组比较，差异有统计学意义（P＜0.05）；中、重度左心功能不全组与正常对照组比较及左心功能不全各组间比较，差异均有显著统计学意义（P＜0.01）；左心功能不全各组随着LVEF减低，SDI逐渐增高；②轻、中、重度左心功能不全组患者左室收缩不同步比例分别为6.67%（2，30）、38.24%（13，34）、68.75%（22，32），中、重度与轻度左心功能不全组比较，差异均有显著统计学意义（P＜0.01）；重度与中度左心功能不全组比较，差异有统计学意义（P＜0.05）；③宽、窄QRS波群左心功能不全组左室收缩不同步比例分别为79.06%（50，64）、56.25%（18，32），差异有统计学意义（P＜0.05）；④SDI与LVEF之间有良好的负相关性（r=-0.752，P＜0.001），与QRS间期呈弱相关（r=0.256，P=0.011）。结论：RT-3DE可以评价左心功能不全患者左室收缩同步性并提供了筛选心脏再同步化（CRT）患者的新方法。

Assessment of left ventricular systolic synchrony in left heart insufficiency by real-time three-dimensional echocardiography

Objective：To Discuss the clinical value of real-time three-dimensional echocardiography for studying LV systolic synchrony in patients with left heart insufficiency.Methods：Normal control group consisted of 31 normal subjects,and left heart insufficiency group included 96 patients.Patients in left heart insufficiency group were divided into three subgroups according to LVEF and two subgroups on the basis of QRS width.The former consisted of mild（30）,moderate（34） and severe（32） left heart insufficiency patients,and the latter included narrow QRS duration group（32） and wide QRS duration group（64）.Real-time three-dimensional echocardiography volume-time curves of all subjects were analyzed,the cut-off value used to define LV systolic dys-synchrony was defined arbitrarily as the mean＋3SD of the Tmsv16-SD% value found in normal control group.Results：SDI increased with worsening of LV systolic function（mild,2.71%±4.52%;moderate,5.56%±2.22%;severe left heart insufficiency,7.88%±1.67%;P for trend 〈0.01）;The SDI was higher in patients with mild left heart insufficiency,compared with 1.54%±0.85% in normal subjects（P〈0.05）;The SDI was significantly higher in patients with moderate,severe left heart insufficiency,compared with normal subjects（P〈0.01）.Left ventricular systolic dys-synchrony was observed in 6.67%（2,30）,38.24%（13,34）,68.75%（22,32） in patients with mild,moderate,severe left heart insufficiency respectively.There were significant difference between the moderate,severe and mild left heart insufficiency group（P〈0.01）;there were difference between the moderate and severe left heart insufficiency group（P〈0.05）.Left ventricular systolic dys-synchrony was observed in 56.25%（18,32）,79.06%（50,64） patients with narrow and wide QRS duration group,there were difference between them（P〈0.05）.Significantly negative correlation was presented in patients with left heart insufficiency group between LVEF and SDI（r=-0.752,P〈0.001）,weak correlation was found between SDI and QRS duration（r=0.256,P=0.011）.Conclusion：RT-3DE can be used to assess the left ventricular systolic synchrony and represent a novel technique to identify left heart insufficiency who may otherwise not be considered for CRT.