实时三维超声心动图节段运动幅度牛眼图定量分析心力衰竭患者心肌节段运动同步性

Quantitative assessment of left ventricular segmental motion synchronicity in patients of heart failure using illustration of the bull eye with real-time three-dimensional echocardiography

目的探讨实时三维超声心肌节段运动幅度牛眼图评价心力衰竭患者左心室心肌节段运动同步性的临床价值。方法23例临床确诊的心力衰竭患者为心力衰竭组,25名健康志愿者为对照组。应用PhilipsiE-33配置的Qlab定量分析软件对两组患者的心肌节段运动幅度牛眼图进行定量分析,并获得左心室整体与节段容积-时间曲线,参数包括左心室舒张末容积(EDV)、收缩末容积(ESV)、左心室射血分数(EF)、每搏量(SV)、左心室最大射血速率(PER)、左心室最大充盈速率(PFR),左心室17节段最大运动幅度(Emax)、最小运动幅度(Emin)、平均运动幅度(EA)、运动幅度标准差(SD)、左心室节段运动幅度离散度(SD/EA)。结果心力衰竭组的EF较对照组减低,EDV、ESV值大于对照组(P<0.05);PER、PFR、Emax、Emin、EA、SD、SD/EA均小于对照组(P均<0.001);心力衰竭患者左心室节段运动同步性异常,在空间分布上无一定规律可循。结论实时三维超声心动图心肌节段运动幅度牛眼图能全面显示心室容积、室壁运动及功能动态变化,为心力衰竭患者的诊断、CRT治疗及预后评估提供更完整的定量信息;Emax、Emin、EA、SD/EA等可作为定量评价左心室收缩运动同步性的有效指标。

Objective To assess the value of illustration of the bull eye （IBE） with real-time three-dimensional echocardiography in evaluating left ventricular segmental motion synchronicity in patients with heart failure （HF）. Methods A total of 23 patients of HF （HF group） and 25 normal subjects （control group） were enrolled. IBE, the global and regional volumetime curve was obtained with Philips Qlab software （version 5.0）. The end diastolic volume （EDV）, end systolic volume （ESV）, left ventricular ejection fraction （EF）, left ventricular peak ejection rate （PER）, left ventricular peak flow rate （PFR）, maximum excursion （Emax）, minimum excursion （Emin）, average excursion （EA）, standard deviation of excursion （SD） and dispersion of excursion （SD/EA） were derived. Results EF in HF group was lower than that in control group, while EDV and ESV were on the contrary （P〈0.05） ; PER, PFR, Emax, Emin, EA, SD, SD/EA in HF group were lower than those in control group （P〈0. 001）. Left ventricular segmental motion synchronicity was abnormal in patients with HF and had no distribution rule. Conclusion Real-time three-echocardiography＇s IBE can be used to evaluate left ventricular global and segmental volume, wall motion, function and systolic synchrony. Emax, Emin, EA, SD/EA are potential parameters for assessing left ventricular systolic synchronicity.