实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性

Assessment of left ventricular systolic synchronicity in patients with heart failure by real-time three-dimensional echocardiography

目的应用实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性。方法选择诊断为心力衰竭的患者21例作为心力衰竭组,同期另选健康志愿者20例作为正常组。实时三维经胸超声心动图检查,应用Qlab软件计算左心室整体和17节段容积时间曲线变化,参数包括左心室舒张末容积、左心室收缩末容积和LVEF。分别计算左心室16、12和6节段达最低左心室收缩末容积时间(Tmsv)的标准差(Tmsv 16-SD、Tmsv-12 SD、Tmsv 6-SD)、左心室16、12和6节段Tmsv的最大时间差异(Tmsv16-Dif、Tmsv 12-Dif、Tmsv6-Dif)。同时系统将所测的绝对值自动进行标准化,得到左心室1 6、12和6节段最大差异的标准化值(Tmsv16-SD/R-R、Tmsv12 SD/R R、Tmsv6-SD/R-R、Tmsv16-Dif/R-R、Tmsv12-Dif/R-R、Tmsv6-Dif/R-R)。结果与正常组比较,心力衰竭组LVEF明显降低,左心室舒张末容积和左心室收缩末容积明显升高,差异有统计学意义(P<0.05);Tmsv16-SD、Tmsv12-SD、Tmsv6-SD,Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif,Tmsv16-SD/R-R、Tmsv12-SD/R-R、Tmsv 6-SD/R-R,Tmsv16-Dif/R R、Tmsv12-Dif/R-R、Tmsv6-Dif/R-R参数值均明显升高,差异有统计学意义(P<0.01)。结论实时三维超声心动图的左心室容积时间曲线能全面显示心室容积、室壁运动及功能的动态变化,为心力衰竭患者的诊断、心脏再同步化治疗及预后评估提供更完整的定量信息。

Objective To assess left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with heart failure（HF）. Methods Twenty-one patients of HF with abnormal wall motion（HF group） and twenty normal subjects（control group） were examined by real-time three-dimensional echocardiography,the global and regional volume-time curves were calculated by Qlab software（version 4.2）. The lef ventricular end diastolic volume（LVEDV） and lef ventricular end systolic volume（LVESV） of left ventricle,left ventricular ejection fraction （LVEF） ,the time to minimal systolic volume of 16,12,6-segmental standard deviation（Tmsv 16- SD, Tmsv 12-SD, Tmsv 6-SD）, maximal difference （Tmsv 16-Dif, Tmsv 12-Dif, Tmsv 6-Dif） were de- rived. The above parameters as percentages of the cardiac cycle with different heart rates between patients also calculated by the software, which were Tmsv 16-SD%, Tmsv 12-SD%, Tmsv6-SD%, Tmsv 16-Dif%, Tmsv 12-Dif%, Tmsv 6-Dif% respectively. Results LVEF, LVEDV, LVESV, Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-Dif, Tmsv 12-Dif, Tmsv 6-Dif were significantly different between the two groups （P ~ 0.05）. Conclusion Real-time three-dimensional echocardiography＇s volume-time curves can be used to evaluate left ventricular global and segmental volume, wall motion, function and systolic synchrony. Tmsv 16,12,6-SD, Tmsv 16,12,6-Dif were potential parameters for assessing left ventricular systolic synchronicity.