超声新技术对心衰患者左室收缩不同步性的研究

目的：应用组织速度成像（TVI）、应变成像（SI）、应变率成像（SRI）技术及实时三维超声心动图（RT-3DE）评价心力衰竭患者左室心肌收缩不同步性。方法：57例研究对象分为2组，A组为27例正常者，B组为30例心衰患者。将B组患者根据LVEF值分为轻度（6例）、中度（18例）和重度（6例）；根据心电图QRS波宽度分为窄QRS波组（22例）和宽QRS波组（8例）。分别测量其左室心肌各节段组织速度收缩达峰时间（Tv）、应变率收缩达峰时间（Tsr）、应变收缩达峰时间（Ts）、最小容积达峰时间（Tmv）和心动周期，并计算其SDI。应用RT-3DE测量LVEF。结果：TVI、SI、SRI及RT-3DE均可检测心衰患者左室心肌收缩不同步性。正常组和轻、中、重度心衰组相比较，4组间有显著性差异（P<0.05）。A组心肌的组织速度、应变、应变率及RT-3DE容积－时间曲线排列有序，而B组曲线却杂乱无章。宽QRS波组和窄QRS波组心衰患者的SDI无显著性差异。LVEF和SDI有良好的负相关性。同时发现，LVEF和SDI相关性方面，RT-3DE和TVI优于SRI和SI技术。结论：TVI、SI、SRI及RT-3DE均可无创、定量评价左室心肌收缩不同步性, 但RT-3DE提供了一种更加快速、简便、准确的检测方法。

Quantitative evaluation of left ventricular myocardial systolic dyssynchrony in patients with heart failure by TVI, SI, SRI and RT-3DE

Objective: To evaluate left ventricular myocardial systolic dyssynchrony in patients with heart failure(HF) by tissue velocity imaging(TVI), strain rate imaging(SRI), strain imaging(SI) and real-time three-dimensional echocardiography(RT-3DE). Methods: Fifty-seven subjects were divided into two groups. Group A consisted of 27 normal subjects, and group B included 30 patients with HF. Patients in group B were divided into three subgroups according to LVEF and two subgroups on the basis of QRS width. The former consisted of mild(6), moderate(18) and severe(6) HF patients, and the latter included narrow QRS subgroup(22) and wide one(8). Tissue Doppler imaging(TDI) and full volume were performed with Philips IE33. The times to the point of peak velocity(Tv), strain rate(Tsr), strain(Ts) during systolic phase, to the point of minimal volume(Tmv) and cardiac cycle were obtained by the on-line Qlab software. The LVEF was derived from RT-3DE. Results: LV systolic dyssynchrony in patients with HF was evaluated by TVI, SRI, SI and RT-3DE. There was significant difference in normal subjects, mild, moderate and severe HF patients(P<0.05). Curves in group A arranged orderly by TVI, SRI, SI, and RT-3DE, while that in group B ranked disorderly. There was no significant difference of SDI between wide QRS subgroup and narrow one. Significant negative correlation existed between LVEF and SDI, where RT-3DE and TVI appeared better than SRI and SI. Conclusion: All the TVI, SRI, SI and RT-3DE can evaluate LV systolic dyssynchrony noninvasively and quantitatively, but RT-3DE can provide a novel, quick and convenient technique.