组织多普勒显像评价心衰患者心肌运动

Assessment of intraventricular synchrony in patients with heart failure using tissue Doppler imaging(TDI)

目的应用组织多普勒成像技术评价心力衰竭患者左室内心肌收缩和舒张运动的同步性情况。方法本研究共收入25例正常人和70例心力衰竭患者,心力衰竭患者又根据心电图QRS波群宽度分为三个亚组:窄QRS亚组(QRS宽度小于120ms)23例;QRS中度延长亚组(QRS宽度在120ms至150ms之间)26例;QRS重度延长亚组(QRS宽度大于150ms)21例。应用组织多普勒技术中的组织速度成像,测量左心室各节段长轴方向的收缩达峰时间(TS),舒张早期达峰时间(TE)。计算12节段TS和TE的标准差(TS-SD和TE-SD)和极差(TSmax-min和TEmax-min),评价左心室收缩舒张同步性。结果收缩期同步性指标TS-SD在对照组和心力衰竭三个亚组中分别为18.60(7.89)ms、27.02(11.16)ms、38.37(15.52)ms、47.28(19.06)ms,心力衰竭亚组与对照组相比均有统计学意义,P<0.05。舒张期同步性指标TE-SD在对照组和心力衰竭三个亚组中分别为19.53(6.4)ms、35.40(16.92)ms、45.66(21.22)ms、51.93(27.92)ms,心力衰竭亚组与对照组相比均有统计学意义,P<0.05。三组心力衰竭患者中收缩期收缩失同步的比率分别为39%、62%、76%,与正常对照组相比有明显统计学意义,P<0.001;三组心力衰竭患者中舒张失同步的比率分别为52%、69%、81%,与正常对照组相比有明显统计学意义,P<0.001。结论心力衰?

Objective To evaluate the intraventricular synchrony in patients with heart failure whose QRS duration is normal or prolonged. Methods Echocardiography and tissue Doppler imaging were performed in 95 subjects.25 served as normal controls,23 patients had HF and narrow QRS duration (<120ms group1), 26 patients had HF and moderate QRS duration between 120 and 150 ms ( group2),21 patients had HF and wide QRS duration≥150 ms (group3).Standard echocardiography were performed,LVEDD and LVEF were measured.Tissue Doppler imaging was performed in apical view.The time to peak myocardial systolic contraction (TS) and early diastolic relaxation (TE) were measured,and the standard deviation and maximal difference of TS and TE of the 12 LV segments were computed,that's TS-SD,TS max-min ,TE-SD,TE max-min. Results The mean (SD) in TS-SD(controls 18.60(7.89)ms V group1. 27.02(11.16)ms V group2. 38.37(15.52)ms V group3. 47.28(19.06)ms, all P<0.05 V controls= was prolonged in all of the HF groups,compared with the normal.Similarly,the mean (SD) in TE -SD (controls 19.53(6.40)ms V group1. 35.40(16.92)ms V group2. 45.66(16.92)ms V group3. 51.93(27.92)ms,all P<0.05 V controls= was prolonged in in all of the HF groups compared with the normal.The prevalence of systolic dyssynchrony was 39%,62% and 76%,respectively in group1,group2 and group3;the prevalence of diastolic dyssynchrony was 52%,69% and 81%,respectively in group1,group2 and group3. Conclusion Not only the prolonged but also normal QRS duration HF patients present intraventricular systolic and diastolic mechanical dyssynchrony.As QRS duration is not a determinant of systolic dyssynchrony,it implies that assessment of intraventricular synchronicity is probably more important than QRS duration in considering cardiac resynchronisation treatment.