实时三维超声心动图在心脏再同步化治疗中的应用

Application of real-time three-dimensional echocardiography in cardiac resynchronization therapy

目的探讨实时三维超声心动图评价左心室不同步性在心脏再同步化治疗（CRT）中的应用价值。方法选择22例扩张型心肌病并接受心脏再同步化治疗患者,应用实时三维超声心动图检测治疗前后QRS起始点到左心室16节段最小收缩容积时间的标准差即收缩期不同步化指数（SDI）、左心室射血分数（LVEF）和舒张末容积（EDV）,根据治疗6个月后NYHA分级随访分为A、B二组,对二组所得参数进行比较。结果22例患者中有15例NYHA分级提高达2级或以上（A组）,7例NYHA分级提高未达2级（B组）。A组术前SDI较高,CRT后SDI减小、LVEF增加、EDV减小,与术前比较差异有统计学意义（P均〈0.0001）。B组术前SDI较低,CRT后SDI和EDV较术前增加（P=0.002和〈0.0001）,LVEF没有明显变化（P=0.457）。两组患者术前SDI和LVEF差异有统计学意义（P均〈0.0001）,而年龄、心率、QRS间期、左室舒张末内径、EDV差异无统计学意义。结论实时三维超声心动图不仅可用于评价左心室不同步性,还可预测心脏再同步化治疗的效果。

Objective To evaluate the value of real-time three-dimensional echocardiography（RT-3DE）on left ventricular dyssynchrony in cardiac resynchronization therapy（CRT）.Methods Twenty-two patients with dilated cardiomyopathy（DCM）underwent CRT.RT-3DE was performed before and after CRT.At six months follow-up,the patients were divided into two groups by NYHA class.The standard deviation of the time to point with minimal systolic volume of all 16 segments,i.e.systolic dyssynchrony index（SDI）,left ventricular ejection fraction（LVEF）,and end-diastolic volume（EDV）in two groups were compared.Results Of all twenty-two patients,fifteen patients reported an increase in NYHA to two grades or more（Group A）,and other seven patients reported an increase in NYHA less two grades or no change（Group B）.Group A with higher SDI demonstrated a significant reduction in SDI,an increase in LVEF and a reduction in EDV after CRT（all P〈0.0001）.Group B with lower SDI demonstrated an increase in SDI and EDV（P=0.002,〈0.0001,respectively）,no change in LVEF（P=0.457）after CRT.There were remarkably difference in SDI and LVEF between two groups before CRT（all P〈0.0001）,but similar in age,heart rate,QRS,LVIDd and EDV.Conclusions RT-3DE not only can be used for assessment of left ventricular dyssynchrony,but also predict the effect of CRT.