实时三平面组织同步性成像检测慢性心力衰竭伴宽QRS波群患者左心室失同步研究

Assessment of left ventricular dyssynchrony in chronic heart failure patients with wide QRS complex by real-time triplane echocardiography

目的研究实时三平面组织同步性成像(RT3P-TSI)对慢性心力衰竭(CHF)伴宽QRS波群患者左心室同步性的评估意义。方法选择CHF伴宽QRS波群患者75例,对照组75例,分别以RT3P-TSI技术和传统二维组织同步性成像(2D-TSI)技术测量同一心动周期下各个节段收缩达峰时间(Ts)并进行定量分析。比较RT3P-TSI和2D-TSI测量CHF患者及对照组左心室失同步情况,同时比较两种技术操作时间。15d后复测比较操作者间变异及操作者本人变异。结果与对照组相比,CHF组左心室各节段Ts及各节段收缩达峰时间最大差值(Ts-diff)明显延长(P<0.01),CHF组后壁基底段Ts最大,侧壁基底部次之,对照组后壁基底段Ts最大,其次为下壁基底部。以收缩达峰时间标准差(Ts-SD)≥33ms判断为左心室失同步,QRS时间≥130ms患者中,2D-TSI法测量CHF组与对照组左心室失同步率分别为81.34%、65.21%(P<0.05),RT3P-TSI法测量CHF组与对照组左心室失同步率分别为80.0%、71.7%(P>0.05)。Pearson相关性分析提示2D-TSI与RT3P-TSI测量Ts及Ts-SD值相关性良好(r=0.85、0.57,均P<0.01)。RT3P-TSI检查花费时间(59.8±11.8)s,低于2D-TSI(155.6±13.4)s。RT3P-TSI法操作者内变异率及操作者间变异率均低于2D-TSI法。结论 CHF伴宽QRS波群患者左心室失同步率高于宽QRS波群但无CHF患者,CHF组左心室各节段收缩延迟,后壁基底段收缩最缓慢。采用RT3P-TSI可以得到与二维方法相近的左心室运动同步信息,其优势是切面规范,人为干扰减少,操作简便快捷。

Objective To investigate the application of real-time triplane tissue synchronization imaging(RT3P-TSI)in assessment of left ventricular synchrony for chronic heart failure(CHF)patients.Methods Seventy five CHF patients with wide QRS complex and75controls were enrolled in the study.The subjects underwent RT3P-TSI and conventional two dimensional TSI(2D-TSI)examinations.The dyssynchrony indices in six basal and six middle segments of left ventricle were compared between the two methods.Time consuming during examination was recorded;interobserver and intraboserver variability were calculated15days later.Results In the CHF group,the values of Ts and Ts-diff were significantly larger than those in control group(P<0.01).The biggest value of Ts in CHF group was observed in posterior basal segment,followed by lateral basal segment.When using Ts-SD≥33ms as definition for systolic dyssynchrony,the rate of dyssynchrony in CHF group was higher than that in control group(81.34%vs65.21%,P<0.05as measured by2D-TSI,80.00%vs72.57%,P>0.05,as measured by RT3P-TSI).Pearson correlation analysis showed that the correlations between Ts and Ts-SD value calculated by two methods were moderate to high(r=0.85,0.57).The examination time of RT3P-TSI was lower than that of2D-TSI(59.8±11.8vs155.6±13.4sec).Interobserver and intraboserver variability in evaluation of Ts by RT3P-TSI were lower than that by2D-TSI.ConclusionThe prevalence of left ventricle dyssynchrony was much higher in CHF patients with wide QRS complex than that in non-CHFpatients with wide QRS complex.In CHF patients the left ventricle contracts are delayed in most segments,particularly in posterior wall.The RT3P-TSI method demonstrates excellent agreement with conventional2D-TSI in evaluation of left ventricular synchronization with less time consuming and less variability.