实时三维超声心动图评价左心室心肌收缩同步性的初步临床研究

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography

目的初步探讨了实时三维超声心动图及其定量技术分析心肌运动同步性的临床应用价值。方法15例研究对象分为二组,A组为8例临床和超声均无异常发现者,B组为7例超声发现有室壁运动异常者。对所有研究对象进行实时三维经胸超声心动图检查,应用Qlab定量分析软件,对三维数据库进行定量评价,得到左室整体容积曲线、17节段容积曲线,舒张末容积(EDV)、收缩末容积(ESV)和左室射血分数(LVEF),17节段的平均最大容积(Vmax)及其标准差(Vmax-SD)、平均最小容积(Vmin)及其标准差(Vmin-SD),最小容积点距离心电图Q波起始点的平均时间(T)及其标准差(T-SD),17个节段中的最小容积点距离心电图Q波起始点的最大时间差(Tmax)。结果A、B两组的年龄、心率和EDV差异均无显著性意义(P>0.05),B组的ESV显著大于A组(P<0.05),B组的LVEF显著小于A组(P<0.05)。A组和B组的Vmax、Vmin和T差异均无显著性意义(均P>0.05),而Vmax-SD、Vmin-SD、T-SD和Tmax差异均有显著性意义(P<0.05),尤其以T-SD和Tmax更为显著(P=0.003和0.004)。结论实时三维超声心动图能够评价左室心肌收缩同步性,T-SD和Tmax可作为评价左室心肌收缩同步性的有效指标。

Objective To assess left ventricular systolic synehronieity by real-time three-dimensional echocardiography. Methods Fifteen subjects were divided into two groups. Group A consisted of eight normal subjects, and group B included seven patients with abnormal wall motion. Philips IE33 with X3-1 probe was used to perform full volume real-time three-dimensional echocardiography（3DE）, and the global and 17-segmental volume curves were obtained by the on-line Qlab software. The end-systolic volume （ESV）, end-diastolic volume（EDV）, left ventrieular ejection fraction （LVEF）, the mean minimal volume of the 17 segments（Vmin） and its standard deviation（Vmin-SD）, the mean maximal volume of the 17 segments（Vmax） and its standard deviation（Vmax-SD）, the mean time to the point of minimal systolic volume（T） of the 17 segments and its standard deviation（T-SD）, and the maximal difference of T among all 17 segments（Tmax） were derived. Results There were no difference in age, heart rate and EDV between the two groups（ P〉0.05）. ESV of group B was significantly larger than that of group A（ P〈0.05）, and LVEF of group 13 was significantly lower than that of group A（ P〈0.05）. Vmax, Vmin and T were not significantly different between the two groups （all P〉0.05）, however Vmax-SD, Vmin-SD, T- SD and Tmax were significantly larger in group B than those in group A（all P〈0.05）, especially T-SD and Tmax of group B were remarkably longer than those of group A（ P = 0. 003, 0. 004, respectively）. Conclusions Real-time three-dimensional echocardiography is a useful modality to evaluate systolic synchrony. T-SD and Tmax may be potential parameters for assessing left ventricular systolic synchronicity.