实时三维超声心动图评价扩张型心肌病患者左心室心肌不同步及其与收缩功能的相关性

Correlation among segmental dyssynchrony, regional ejection fraction and global ejection fraction of left ventricle in patients with dilated eardiomyopathy by real-time three-dimensional eehocardiography

目的应用实时三维超声心动图技术探讨扩张型心肌病患者左心室节段心肌不同步化指数、节段射血分数与左室整体射血分数的关系。方法对27例正常人和24例扩张型心肌病不同步化患者（DCM）进行三维图像采集，将左室心肌划分为基底、中间、心尖三个节段，测量左室射血分数（LV—EF）、节段射血分数（REF）、三个节段到达最小收缩末期容积时间的标准差（Tmsv Sel—SD）和最大时间差（Tmsv Sel—DIF）。结果DCM组中间段的Tmsv Sel—SD、Tmsv Sel—DIF与中间段的REF呈线性负相关（r=-0．6921，-0．6384，P〈0．01）。DCM组三节段Tmsv Sel—SD、Tmsv Sel—DIF与LV—EF的多元回归方程中仅中间段的Tmsv Sel—SD、Tmsv Sel—DIF与LVEF存在回归关系（β=-0．7836，-0．7801，P〈0．01）。DCM组三节段REF与LV—EF的多元回归方程中三节段REF与LV—EF均存在回归关系（β=0．2234，0．7506，0．1880，P〈0．05），中间段REF对LV—EF的贡献最大。结论DCM不同步化患者中间段的Tmsv Sel—SD、Tmsv Sel-DIF及REF是影响其左室收缩功能的重要因素。

Objective To evaluate the relationship among segmental dyssynehrony indexes, reginal ejection frction（EF） and global EF of left ventricle（LV） in the patients with dilated cardiomyopathy. Methods Standard deviation（SD） and maximal difference （Dif） in the time to minimal systolic volume in user-selected LV segments （Tmsv Sel-SD, Tmsv Sel-DIF） of LV global EF（LV-EF）, reginal ejection fraction （REF） were acquired by real-time three-dimensional eehocardiography in 27 controls and 24 DCM dyssynchrony patients. Data were grouped separately for 3 levels of the basal, mid and apical segments. Results The values of Tmsv Sel-SD and Tmsv Sel-DIF were linearly negatively correlated with REF in mid segment of DCM （ r = - 0. 6921, - 0. 6384, P 〈0.01）. It existed exclusive linear regression between Tmsv Sel-SD,Tmsv Sel-DIF and LV EF only in mid segment＇s dyssynchrony indexes among three segments （ β=-0. 7836,- 0. 7801, P〈0.01）. Each REF in three segments was linear regression relationship with LV- EF（β = 0. 2234,0. 7506,0. 1880, P 〈0.05） especially in mid segment. Conclusions The Tmsv Sel SD, Tmsv Sel-DIF and REF of mid segment are important factors to influence left ventrieular function in the patients with dilated cardiomyopathy.