实时三维超声心动图评价扩张型心肌病左心房同步性价值初探

Initial Study of Real-Time Three-Dimensional Echocardiography in Left Atrial Synchronicity in Patients with Dilated Cardiomyopathy

目的:探讨实时三维超声心动图(RT-3DE)评价扩张型心肌病(DCM)左心房内同步性的临床应用价值。方法:选择DCM组共31例和正常人30例,应用RT-3DE测量左心房16节段、12节段、6节段QRS起点达最小收缩容积时间标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD)及离均差(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif),测量左心房最大容积(LAVmax)、最小容积(LAVmin)及收缩前容积(LAVpre),计算左心房整体射血分数(LAEF)、被动射血分数(LAEFpassive)及主动射血分数(LAEFactive)。结果:与正常组比,DCM组左心房16节段、12节段及6节段不同步参数较正常组明显增大(均P<0.05);LAVmax、LAVpre、LAVmin指数较正常组增大,而LAEF、LAEFpassive、LAEFactive较正常组降低(均P<0.05)。左心房不同步参数与心房容积与功能均存在一定相关关系,其中左心房Tmsv16-SD、Tmsv16-Dif与LAVmax指数呈正相关(r分别为0.71、0.74,均P<0.01),与LAEF呈负相关(r分别为-0.69、-0.72,均P<0.01)。结论:RT-3DE可准确检测DCM左心房机械运动不同步情况,左心房内机械运动不同步与左心房扩大及整体功能降低关系密切。

Objective：To evaluate the clinical significance of real-time three-dimensional echocardiography （RT-3DE） in left atrial asynchrony in patients with dilated cardiomyopathy （DCM）. Methods：Thirty-one patients with DCM and 30 healthy subjects underwent RT-3DE. The asynchrony parameters of left atrial 16-, 12-and 6-segment models were measured including the standard deviation （Tmsv 16-SD,Tmsv 12-SD and Tmsv 6-SD） and maximal difference of QRS to Tmsv（Tmsv 16-Dif,Tmsv 12-Dif and Tmsv 6-Dif）. The values of maximun left atrial volume （LAVmax） index, minimum atrial volume （LAVmin） index and volume before atrial active contraction （LAVpre） index were measured. The values of left atrial emptying passive atrial emptying fraction （LAEF）, passive atrial emptying fraction （LAEFpassive） and active atrial emptying fraction （LAEFactive） were calculated. Results：The asynchrony parameters of left atrial 16-, 12-and 6-segment models were significantly higher in DCM group than those in the control （P 0.05）. The values of LAVmax index, LAVpre index and LAVmin index were higher, whereas the values of LAEF, LAEFpassive and LAEFactive were lower in DCM group than those in the control group （P 0.05）. Moreover, there were correlation between asynchrony parameters of left atrial 16-, 12-and 6-segment models and left atrial volume and function. There were positive correlations between left atrial Tmsv16-SD,Tmsv 16Dif and LAVmax index （r = 0.71, 0.74, P 0.01, respectively）, and negative correlations between left atrial Tmsv16-SD,Tmsv 16 Dif and LAEF （r =-0.69,-0.72, P 0.01,respectively）. Conclusion： RT-3DE is an useful ultrasonic technique that can accurately detect left atrial asynchrony in patients with dilated cardiomyopathy. There was a close relationship between left atrial asynchrony and left atrial dilate and decreased atrial function.