组织同步成像评价缺血性心肌病患者左心室心肌运动不同步状况

Assessment of the characteristics of myocardium asynchrony of left ventricular in patients with ischemic cardiomyopathy by tissue synchronization imaging

目的探讨组织同步成像（TSI）技术评价缺血性心肌病（ICM）患者心室运动不同步状况的临床应用价值。方法ICM患者38例，分为两组：A组不伴左束支传导阻滞（LBBB）26例，B组伴LBBB12例。26例健康查体者为对照组。在TSI模式下，根据二维图像颜色对比各组各节段心肌运动情况，计算左室12个节段收缩期达峰速度时间的标准差（Ts—SD）、舒张早期达峰速度时间的标准差（Te—SD）、收缩期达峰时间差值（Tsmax-min）、舒张期达峰时间差值（Temax-min），以评价各组心室内同步性。结果①TSI检查对照组91．8％节段运动无延迟，8．2％节段运动轻度延迟。在所有ICM患者中，心肌表现为绿～黄～红浓度明显不均分布，黄色或红色的节段数较对照组明显增多。②ICM组左室12节段TsSD、Tsmax-min均明显大于对照组（P〈0．05）。ICM组内比较，B组患者的收缩同步性更差（P〈0．05）。③ICM组左室12节段Te—SD、Temax-min均明显大于对照组。ICM组内比较，B组ICM患者的舒张同步性更差（P〈0．05）。④ICM患者收缩后收缩（PSS）现象比较普遍，A组32．4％个节段、B组56．0％节段具有PSS现象。结论ICM患者存在较为明显的收缩和舒张不同步，且PSS现象比较普遍，伴有LBBB的ICM患者收缩和舒张不同步更加严重。TSI是评价心肌运动非同步状况的理想方法。

Objective To explore the clinical value of tissue synchronization imaging（TSI） in assessment of the characteristics of myocardium asynehrony in patients with ischemic cardiomyopathy（ICM）. Methods Thirty-eight patients with ICM were divided into two groups：26 patients without left bundle branch block（LBBB） in group A,and 12 patients with LBBB in group B. The control group consisted of 26 normal healthy subjects. According to 2D color, the characteristics of myoeardium motion in each group were compared by TSL The time for reaching systolic velocity peak （Ts） and early diastole velicity peak （Te） were measured separately in 12 segments. Standard deviations of Ts（Ts-SD） and Te（Te-SD） as well as difference of Ts（Ts max-rain） and Te（Te max-min） of all 12 segments were calculated. The myocardium synchronization were assessed in each group. Results ①91.8% segments in the control group showed normal, with only 8. 2% segments were slightly prolonged. TSI of all the ICM patients showed an obvious uneven chroma distribution from green to yellow and then to red. There were far more yellow or red segments than in the control group. ②Ts-SD,Ts max-min of LV 12 segments were significantly prolonged in all ICM groups compared with that in the control group（ P 〈0. 05）. Systolic asynchrony was more obvious in group B than in group A.③Te-SD,Te max-min of LV 12 segments were significantly prolonged in ICM groups than in the control group （ P 〈 0.05）. Diastolic asynchrony was more obvious in group B than in group A（ P 〈0.05）. ④ Compared with that in the control group, postsystolic shortening（PSS） was common in patients with ICM. 32.4% segments of group A were detected PSS,and 56.0% segments of group B were detected PSS. Conclusions Left ventrieular systolic and diastolic mechanical asynchrony is obvious in patients with ICM and PSS is common among them. Systolic and diastolic mechanical asynchrony is more severe in ICM patients with LBBB. TSI is the optimal means to evaluate the characteristics of asynchronous myocardial contraction.