实时三维超声心动图和组织多普勒对左心室内收缩同步性的评价

Assessment of intra-left ventricular systolic synchronism by real-time three-dimensional echocardiography and tissue Doppler imaging

目的比较实时三维超声心动图(RT-3DE)和组织多普勒显像(TDI)对左心室内收缩同步性的评价,并探讨RT-3DE定量评价左心室同步性的价值。方法选择慢性心力衰竭患者52例,按QRS间期≤120ms为窄QRS心衰组27例,QRS间期>120ms为宽QRS心衰组25例,另设正常对照组30例,运用RT-3DE获得左心室12节段(基底段和中间段)达最小收缩容积时间的标准差(Tmsv-12-SD)和最大差(Tmsv-12-Dif),采用TDI测量左心室非心尖12节段达收缩峰值速度时间的标准差(Ts-SD)和最大差(Ts-Dif),并对两种方法所得结果进行比较。结果正常对照组的Tmsv-12-SD、Tmsv-12-Dif、Ts-SD、Ts-Dif分别为(10.1±5.5)ms、(34.7±20.1)ms、(15.2±5.7)ms、(47.9±16.8)ms。52例心衰患者中RT-3DE共检出不同步32例(62%),TDI检出22例(42%),RT-3DE较TDI发现不同步的比例要高(P<0.05),但两者检出的病例并不完全一致。Tmsv-12-SD与TS-SD,Tmsv-12-Dif与Ts-Dif均为弱相关(r=0.418,P=0.002和r=0.431,P=0.001)。结论对于定量评价左心室内收缩同步性,RT-3DE是一种简单、快捷的方法,与TDI相结合可能是今后的发展方向。

Objective To compare real - time three - dimensional echocardiography （RT- 3DE） and tissure Doppler imaging （TDI） for assessment of intra - left ventricular systolic synchronism and to explore the value of RT - 3DE on quantifing left ventricular synchronism（LVS）. Methods Fifty - two patients with chronic heat failure （27 with narrow QRS duration ,25 with wide QRS duration） and thirty normal controls were enrolled in tiffs study. The standard deviation（Tmsv - 12 - SD） and maximal difference（Tmsv - 12 - Dif） of the minimal systolic volume time to the beginning of QRS wave in 12 segments （ basal segment and middle segment ） by RT- 3DE and the time of standard deviation（Ts - SD） and maximal difference（Ts - Dif） of the peak systolic velocity to the beginning of QRS wave in 12 left ventricular segments by TDI were compared. Results In the normal controls, Tmsv - 12 - SD,Tmsv - 12 - Dif, Ts - SD and Ts - Dif were （10.1 ±5.5）ms,（34.7±20.1）ms,（15.2± 5.7）ms and （47.9± 16.8）ms. In 52 patients, RT-3DE（32/52,62%） found higher proportion of patients with LVS than TDI（22/52,42% ; P〈 0.05）. There are poor correlation between Tmsv - 12 - SD and Ts - SD,Tmsv -12-Dif and Ts-Dif. （r=0.418,P=0.002 and r=0.431,P=0.001）. Conclusion RT- 3DE is a simple and quick method to quantify intra - left ventficular asynchronism, combining with TDI will be the development direction in the future.