充血性心力衰竭患者左室心肌收缩性及非同步性组织速度成像研究

Quantitative tissue velocity imaging(QTVI)on left ventricular myocardium constriction and asynchrony in patients with congestive heart failure

目的利用定量组织速度成像技术(QTVI)对充血性心力衰竭(CHF)患者左室心肌收缩功能评价及其非同步性分析。方法选择左室舒张末期内径(LVIDd)≥60mm,左室射血分数(LVEF)≤40%,NYHA心功能分级Ⅱ-Ⅳ级的CHF患者65例。二维超声采集心尖四腔心、二腔心和左室心尖长轴3个切面,左心6个室壁,利用QTVI分别测量各壁基底段、中间段和心尖段的18个节段收缩期峰值运动速度(Vs),以及6个壁基底段从心电图QRS波群起始到最大收缩峰值时限(Q-Ts),计算其最大差值(Max-△Ts)。与40例正常对照组进行对比研究。结果两组左室心肌各节段Vs规律均表现为基底段>中间段>心尖段(除CHF组后间隔心尖段>基底段>中间段外)。CHF组左室心肌各节段Vs均低于正常对照组,其中降低幅度最大的是基底段达57%,中间段次之为50%,心尖段最少是43%。18个节段中除后间隔的心尖段平均Vs下降值与对照组比较无统计学意义(P>0.05),其他17个节段两组对比均有统计学意义(P<0.05)和显著统计学意义(P<0.01)。CHF6个壁基底段Q-Ts均延长,Max-△Ts平均83.08±40.19ms,与对照组比较有显著统计学意义。结论QTVI技术能准确、同时显示CHF患者室壁多个节段的心肌运动速度和时相,从而了解心肌整体和局部功能,有效评估心肌运动协调性。

Objective To evaluate the left ventricular myocardium constriction and asynchrony in patients with congestive heart failure by QTVI. Methods In total 4,0 normal controls and 65 patients with CHF were studied using QTVI. In the study group the LVIDd of the selected patients was greater than 60mm; LVEF was less than 4,0% ; and the cardiac function was between II-IV ranked with the NYHA. The regional velocity profiles of 18 segments of LV along LV apical long-axis view, apical four-chamber view and two-chamber view were obtained. Peak velocity during systole （Vs） and the time from onset of QRS complexes to Vs （Q-Ts） were measured. The maximal difference among Ts values of six basal segments of LV （Max- A Ts） were calculated. Results The motion velocity of evaluated segments was basal〉 middle〉 apical in both groups, with an exception of the posterior ventricular septum in the study group （apical 〉 basal 〉 middle）. Velocity of LV segment in CHF group was slower in control group, reduced by 57% in basal segment, 50% in middle segment, and 43% in apical segment, respectively. No difference of Vs of the apical segment of anterior wall and the posterior ventricular septum was revealed between both groups, while the Vs of the rest 17 segments in CHF group was significantly prolonged （ P 〈0.05, P 〈 0.01 ）. Q-Ts of basal segments of all six walls of the left ventricle was prolonged in CHF group, with the mean Max-Δ Ts measured 83.08 ±40. 19ms, which was significantly prolonged in CHF group （ P 〈 0. 01 ）. Conclusion QTVI shows the velocity of myocardium motion, phase of ventricular wall segments and general/regional myocardium contractile function, and assess the coordination of myocardium motion as well.