实时三维超声心动图评价心肌梗死后心力衰竭患者左心室收缩功能与不同步性

Evaluation of the left ventricular global function and systolic dyssynchrony in patients with heart failure after myocardial infarction by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图评价心肌梗死后心力衰竭患者左心室收缩功能与不同步性的临床价值。方法对40例心肌梗死后心力衰竭患者(心肌梗死组)及30例健康者(对照组)分别行左室实时三维超声心动图17节段时间-容积分析,获取左室整体收缩功能指标:左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数(LVEF);左室收缩同步性指标:除心尖帽外的16节段从QRS波起点到最小收缩容积的时间的标准差和最大差值(Tmsv16-SD、Tmsv16-Dif);二者除以心动周期分别得到SDI、Tmsv16-Dif%。分析LVEF与SDI之间的关系。结果与对照组比较,心肌梗死组左室扩大,LVEDV、LVESV增高,LVEF减低,差异均有统计学意义(P<0.01),LVEF与LVEDV呈负相关(r=-0.83,P<0.01);心肌梗死组SDI高于对照组(P<0.01),SDI与LVEF呈负相关(r=?0.84,P<0.01)。结论陈旧性心肌梗死患者左心室重构明显,不但心功能减低而且普遍存在收缩不同步,不同步程度与收缩功能呈负相关。实时三维超声心动图能同时提供左室收缩功能和不同步性的详细信息,是评价心功能的有效手段。

Objective To explore the clinical value of real - time three - dimensional echocardiography （ RT - 3DE） in assessment of left ventricular global function and systolic dyssynchrony in patients with heart failure after myocardial infarction. Methods Forty patients with congestive heart failure after myocardial infarction （infarction group）and 30 normal subjects （control group） were enrolled in this study, then the 17-segmental time-volumetric curves was obtained by RT- 3DE, global systolic function parameters （ LVEDV, LVESV, LVEF） and dyssyuchronic parameters （ Tmsvl6-SD, Tmsv16-Dif, Tmsv16- SD%,Tmsvl6-Dif% ,and the Tmsvl6-SD% were served as the systolic dyssynchrony index,SDI） were measured, respectively. The relationship between LVEF and SDI was analyzed. Results Compared with the control group, LVEDV and LVESV in infarction group were significantly increased, and the LVEF was significantly decreased （ P 〈 0. 01 ） , there was negative correlation between LVEF and LVEDV（ r = -0.83,P 〈 0.01 ）. The SDI in infarction group was significantly higher than that in control group （ P 〈 0.01 ） , there was negative correlation between SDI and LYEF（ r = - 0.82,P 〈 0.01 ）. Conclusion The left ventrleular remolding is significant in patients with old myocardial infarction , there is not only reduce of LVEF, but also increase of SDI in these patients, and the two are negatively correlated. RT - 3DE can simultaneously measure the left ventricular systolic function and dyssynchrony, and it is an effective means for evaluating cardiac function.