全方向M型超声与二维应变评价左心室收缩不同步的一致性

Consistency of omnidirectional M-mode echocardiography and two-dimensional strain in assessment of left ventricular systolic asynchrony

目的探讨全方向M型超声与二维应变技术对心力衰竭患者左心室径向收缩不同步评价结果的一致性。方法对30例心力衰竭患者(心力衰竭组)和28名健康志愿者(正常对照组)同时行全方向M型和超声二维应变分析。选取全方向M型超声测定的左心室12节段收缩期运动位移达峰时间的标准差(Tm-12-sd)和最大差值(Tm-12-dif)、二维应变技术测定的左心室12节段径向收缩期应变达峰时间的标准差(Tsr-12-sd)和最大差值(Tsr-12-dif)作为左心室内不同步指标。以正常对照组各测定指标的均数加上2倍标准差作为单侧97.7%上限值。心力衰竭组各测定指标大于该值判定为存在左心室收缩不同步。对两种方法评价心力衰竭组左心室不同步的结果进行一致性检验。结果心力衰竭组左心室12节段的Tm-12-sd、Tm-12-dif、Tsr-12-sd与Tsr-12-dif均大于正常对照组(P<0.001);Tm-12-sd与Tsr-12-sd,Tm-12-dif与Tsr-12-dif对心力衰竭组左心室不同步的检出结果有一致性(Kappa值:0.661、0.733)。结论全方向M型超声与二维应变技术对左心室径向运动同步性的评价结果一致,两种技术均能评价左心室径向运动同步性。

Objective To investigate the consistency of omnidirectional M-mode echocardiography and two-dimensional strain in assessment of left ventricular（LV） radial systolic asynchrony.Methods Thirty patients with heart failure（HF） and 28 healthy volunteers underwent omnidirectional M-mode echocardiography and two-dimensional strain at the same time.The time to peak radial systolic movement（T m） of LV in 12 segments were measured with omnidirectional M-mode echocardiography and its standard deviation（T m-12-sd）,and the maximum difference（T m-12-dif） were calculated.The time to peak radial systolic strain（T sr） of LV in 12 segments were measured with two-dimensional strain and its standard deviation（T sr-12-sd）,and the maximum difference（T sr-12-dif） were calculated.The T m-12-sd,T m-12-dif,T sr-12-sd and T sr-12-dif were used as systolic asynchrony indicators.The value ＊Ax-G±2s in the control group was defined as the normal upper limit which represents 97.7% of the control group distribution.Any values above this limit in HF patients were classified as LV asynchrony.The results of two methods were analyzed with Kappa test.Results Compared with the controls,T m-12-sd,T m-12-dif,T sr-12-sd and T sr-12-dif were significantly higher in the HF group（P 0.001）;there was consistency between T m-12-sd and T sr-12-sd,T m-12-dif and T sr-12-dif in detecting LV systolic asynchrony in HF group（Kappa=0.661,0.733）.Conclusion T m-12-sd and T m-12-dif of omnidirectional M-mode echocardiography have consistency with T sr-12-sd and T sr-12-dif of two-dimensional strain.These two technologies both have ability to evaluate LV radial systolic synchronicity.