实时三维超声心动图评价左室重构心功能的初步探讨

Initial Exploration of Remodeled Left Ventricular Function Evaluated by Real-Time Three-Dimensional Echocardiography

目的 探讨实时三维超声心动图 (RT 3DE)评价重构左室收缩功能的方法及可行性。方法 对 2 6例不同病因所致左室形态重构的患者 ,应用RT 3DE采集左室腔立体数据库 ,测量左室舒张末期容积 (EDV)、收缩末期容积 (ESV)和左室射血分数 (LVEF)。同时应用二维超声 ( 2DE)双平面Simpson’s法和M型 (ME)Teichholz法分别测量左室EF值。在心尖四腔、三腔和两腔心切面上 ,用ME记录二尖瓣瓣环在后间隔、侧壁、后壁、前间隔、下壁、前壁六个位点上运动的平均距离。分别比较RT 3DE与 2DE、ME测值的相关性。结果 RT 3DE能显示完整左室腔的立体形态。RT 3DE测定的LVEF值与二尖瓣瓣环运动的平均距离之间有很好的相关性 (r =0 .90 45 ,P <0 .0 0 1) ,与二维法及M型法测量值之间相关性较低(r =0 .73 5 5 ,r =0 .72 18,P <0 .0 1)。结论 RT 3DE为定量分析左室容积和收缩功能提供了一种无创的 ,准确可信的新途径。

Objective To explore the feasibility and the methods of remodeled left ventricular (LV) function calculated by real-time three-dimensional echocardiography (RT-3DE). Methods RT-3DE images were acquired in 26 patients with remodeled left ventricular cavity and the left ventricular ejection fraction (LVEF) was determined from LV end diastolic volume (LVEDV) and LV systolic volume (LVESV). The LVEDV,LVESV and LVEF were also calculated with two-dimensional echocardiography (2DE) and M mode echocardiography (ME). Meanwhile, the distance of mitral annular movement (MVM) was recorded with ME and the mean MVM was calculated in the 6 wall-position located in posterior septum,lateral wall,posterior wall,anterior septum,inferior wall and anterior wall of left ventricle on apical four and two chamber views as well as long axis three chamber view respectively. Results RT-3DE could show the whole shape of LV. There was excellent correlation between LVEF measured by RT-3DE and mean MAM ( r =0.9045, P <0.001). The correlations between LVEF measured by RT-3DE and LVEF measured by 2D or mean MAM, respectively, were relatively lower ( r =0.7355, r = 0.7218 , P < 0.01 ). Conclusion RT-3DE is a novel noninvasive and reliable method to quantitatively evaluate remodeled LV volume and its systolic function.