心电图QRS间期与慢性心力衰竭左心室同步性关系的超声评价

Left ventricular dyssynchrony evaluated by echocardiography in chronic heart failure patients with normal and wide QRS duration

目的评价心电图QRS间期与慢性心力衰竭（心衰）左心室同步性的关系。方法对54例慢性心衰患者（宽QRS组28例，正常QRS组26例）和15例健康人（对照组）进行心肌组织多普勒成像研究，测量收缩期和舒张早期12节段达峰时间（Ts和Te），评价不同QRS间期的慢性心衰左心室各节段不同步状况以及左心室不同步的主要影响因素。结果慢性心衰舒张末期和收缩末期容积增大，宽QRS组较正常QRS组更加显著，12节段平均Ts显著增大。以Ts≥182ms作为分界值，正常QRS组46％、宽QRS组71％存在收缩期不同步。宽QRS组Te最大差值（Te-diff）最大，以Te-diff≥79ms作为分界值，正常QRS组58％、宽QRS组89％存在舒张期不同步。同时存在收缩期和舒张期不同步者，正常QRS组为31％，宽QRS组为64％。收缩末期容积与左心室收缩期不同步相关，舒张末期容积与舒张期不同步相关。结论心电图QRS间期不能完全反映慢性心衰左心室同步性状况，左心室收缩末期容积和舒张末期容积直接影响左心室的收缩期和舒张期同步性。

Objective The aim of the study is to evaluate the left ventricular （LV） dyssynchrony in chronic heart failure （HF） patients with normal and wide QRS duration. Methods Time to peak velocity at peak systolic and early diastolic phase （Ts and Te） were determined in 12 segments of LV by echocardiography （GE Vivid 7） in 54 HF patients （28 with wide and 26 with normal QRS duration） and 15 normal controls to evaluate LV systolic and diastolic dyssynchrony. The risk factors related to LV dyssynchrony were also evaluated. Results LV end systolic and diastolic volumes were significantly larger and 12 segmental mean Ts and maximal Te difference （Te-diff） were significantly higher in HF patients with wide QRS duration than HF patients with normal QRS duration. Using mean Ts ≥ 182 ms as the cut-off value, systolic dyssynchrony was present in 46% HF patients with normal QRS and 71% HF patients with wide QRS. Using Te-diff≥79 ms as the cut-off value, diastolic dyssynchrony was seen in 58% HF patients with normal QRS and 89% HF patients with wide QRS. Combined systolic and diastolic dyssynchrony was seen in 31% HF patients with normal QRS and in 64% HF patients with wide QRS. Systolic dyssynchrony was significantly correlated to LV end systolic volume and diastolic dyssynchrony was correlated to end diastolic volume. Conclusion Percentage of LV dyssyncrony was significantly higher in HF patients with wide QRS, especially in HF patients with increased LV end systolic and diastolic volume.