实时三维超声心动图对心肌梗死后左室收缩功能及其同步性评价

Evaluation of the left ventricular systolic function and synchrony in patients with myocardial infarction using real-time three-dimensional echocardiography

目的探讨应用实时三维超声心动图(RT-3DE)评价陈旧性心肌梗死患者左心室收缩功能及同步性各参数的可行性及准确性。方法将18例陈旧性心肌梗死患者(心梗组)和16例正常人(正常对照组)分别行二维超声(2DE)和实时三维超声(RT-3DE)检查。2DE法检查左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)和左室射血分数(LVEF)。RT-3DE法应用QLAB定量分析软件对三维数据库进行定量评价,检测左室收缩功能参数LVEF及同步性参数即左室16节段、6个基底段和6个中间段、6个基底段达收缩末最小容积的时间标准差(Tms-vSD-16、TmsvSD-12、TmsvSD-6),上述16、12、6个节段达最小收缩末容积的时间最大差值(Tmsv-16Dif、Tmsv-12Dif、Tmsv-6Dif)及以上各参数经心率校正后值TmsvSD-16%、TmsvSD-12%、TmsvSD-6%、Tmsv-16Dif%、Tmsv-12Dif%和Tmsv-6Dif%。结果与正常对照组相比,心梗组患者的LVEF降低(P<0.05),TmsvSD-16%、Tmsv-16Dif%增加(P<0.05)。RT-3DE法所测的心梗组患者的LVEDV和LVESV高于2DE所测值(P<0.05),LVEF低于2DE所测值(P<0.05)。结论RT-3DE法能客观的定量评价心肌梗死患者左心收缩功能及同步性。TmsvSD-16%、Tmsv-16Dif%可作为评价左室收缩同步性的有效指标。

Objective To explore the feasibility and accuracy of real-time three-dimensional echocardiography （RT-3DE） in evaluation of the left ventricular systolic function and synckrony in patients with myocardial infarction. Methods Two-dimensional echocardiography （2DE） or RT-3DE was performed on 18 patients with myocardial infarction （the myocardial infarction group） and 16 normal people （the control group）. Left ventricular ejection fraction （LVEF）, left ventricular end-diastohc volume （LVEDV）, left ventricular end-systolic volume （LVESV）, the difference（Dif） and standard deviation（SD） of the time to the paint with minimal systolic volume（Tmsv） in 16,12, and 6 segments were determined and adjusted by R-R interval （TmsvSD% and TmsvDif% ） using real-time three-dimensioual echocardiography and QLAB software. LVEDV, LVESV, and LVEF were obtained by 2DE. Results Compared with the control group, LVEF of the myocardial infarction group was decreased（ P 〈 0.05）, while TmsvSD% and TmsvDif% were increased（ P 〈0.05）. LVEDV and LVESV obtained by RT-3DE were higher than those obtained by 2DE（ P 〈 0.05）, while LVEF by RT-3DE was lower than that by 2DE（ P 〈 0.05）. Conclusion RT-3DE can objectively evaluate the left ventricular systolic function and synchrony in patients with myocardial infarction. TmsvSD-16% and Tmsv-16Dif% may be potential parameters for evaluation of systolic synehrony.