门控心血池显像和组织学超声对比评价左心室机械运动同步性的价值

Clinical value of evaluating left ventricular mechanical synchrony by gated blood pool imaging and tissue Doppler imaging

目的 探讨门控心血池显像位相分析法在评价慢性心力衰竭患者左心室机械运动同步性方面的应用价值.方法 选择2009年3-10月我院住院的169例慢性心力衰竭患者,采用核素门控心血池显像位相分析方法获得左心室相角程宽度（PHB）,左心室相角程标准差（PSD）作为评价左心室机械运动同步性的指标;并采用组织多普勒显像（TDI）技术测量左心室12个非心尖节段收缩期峰值速度距QRS起始点时间标准差（Ts-SD）作为评价左心室机械运动同步性指标,对这两种方法所得参数进行比较.结果 门控心血池显像法测定左心室PHB[（91.79±40.14）°]和组织多普勒显像方法测量的Ts-sD[（27.74±13.00）ms]间有良好的相关性（r=0.83,P=0.000）;门控心血池显像法测定左心室PSD[（20.59±12.30）°]与和组织多普勒显像方法获得的Ts-SD[（27.74±13.00）ms]中度相关（r=0.69,P=0.000）.心脏超声法测量的左心室射血分数为（42.93±14.89）%;核素心血池法为（39.76±17.89）%,心脏超声法数值高于核素心血池法,差异有统计学意义（P〈0.01）.结论 门控心血池显像法对慢性心力衰竭患者左心室机械运动同步性的检测能够提供与TDI相似的信息,其可同时测量双室功能,测量射血分数更加准确,可以联合二种方法筛选心脏再同步治疗患者,提高心脏再同步治疗反应率,使更多的心力衰竭患者从心脏再同步治疗中获益.

Objective To investigate the clinical value of the gated blood pool imaging phase analysis method in the evaluation of left ventricular mechanical synchronization in patients with chronic heart failure. Methods A total of 169 patients with chronic heart failure were enrolled in our study , using gated blood pool imaging phase analysis method to obtain left ventricular phase angle width （ PHB） and left ventricular phase angle standard deviation （ PSD） as evaluating left ventricular mechanical synchrony index; using tissue Doppler imaging （TDI） measurement of the standard deviation of systolic peak time（Ts-SD） of each segment by using the current prevailing 12 non-apical segments analysis method as evaluating left ventricular mechanical synchrony index, and parameters derived from both methods were compared. Results LVPHB was highly correlated with Ts-SD （r = 0. 83 ,P = 0. 000 ） . LVPSD was modestly correlated with Ts-SD （ r - 0. 69, P = 0. 000） . The ejection fraction measured by echocardiography was （42.93 ± 14. 89） % ,which was significantly higher than that measured by ERNA （39. 76 ± 17. 89）% （P 〈0. 01）. Conclusions The evaluation of left ventricular mechanical synchrony in patients with chronic heart failure by the gated blood pool imaging can provide similar information with TDI, which can simultaneously measure two ventricular functions and get more accurate measurement of ejection fraction. Cardiac resynchronization therapy patients can be identified by combining two kinds of approaches, and cardiac resynchronization therapy responders could be improved as well. More patients with heart failure can benefit from cardiac resynchronization therapy therapy.