实时三维超声评价先天性心脏病合并肺动脉高压患者的左心功能及同步性研究

Evaluation of left ventricular fraction synchronicity in patients of congenital heart disease combined with pulmonary artery hypertension using real-time three-dimensional echocardiography

目的:应用实时三维超声及二尖瓣环组织多普勒成像技术评价先天性心脏病(先心病)合并肺动脉高压(PAH)患者的左心功能。方法:对12例先心病合并重度PAH患者及正常组12例分别进行二维及三维超声心动图检查,实时三维测量左心室舒张末期容积和收缩末期容积。应用QLAB软件技术描绘左心室容量-时间曲线,计算左心室16节段达最低收缩末容量时间的标准差、最大差异及2者的标准化值。结果:结果显示其左心室容量-时间曲线各节段排列有序,起伏一致。与正常组相比,达最低收缩末容量的时间点几乎在同一条直线,差异无统计学意义。2组左心室射血分数差异无统计学意义。二尖瓣环组织速度成像显示:2组间舒张期二尖瓣环运动速度指标的比较可见重度肺动脉高压患者舒张早期运动速度(Ve)较正常组减低,舒张晚期速度(Va)增高。结论:实时三维超声心动图及组织多普勒技术能够比较准确综合评价先心病合并重度PAH患者的左心功能,实时三维超声心动图左心室容量-时间曲线形态及参数能全面反映PAH患者左心室运动同步性及功能变化。

Objective：To evaluate clinical use of real-time three-dimensional echocardiography and tissue Doppler Imaging in analyzing global and regional left ventricular funtion in congenital heart disease（CHD） with pulmonary artery hypertension（PAH）.Methods： The study consisted of 12 normal subjects and 12 patients with CHD.RT-3DE was performed and three-dimensional image data was analyzed offline with Qlab software.A series of global and regional left ventricular volume curves were plotted.Global and regional diastolic volumes,systolic volumes and ejection fraction were compared between the two groups.Left ventricular peak systolic velocity（Vs） and peak early diastolic systolic（Ve）and peak late diastolic systolic（Va）of left ventricular lateral side of DTI and mitral valve annulus were determined.Results： Compared with control group,the volume time curves were regular parabola and arranged in order.Tmsv16-SD（ms） Tmsv16-SD/R-R Tmsv16-Dif（ms） Tmsv16-Dif/R-R were not significantly different bitween the two groups.Vs were significantly lower and Va were increased in CHD with PAH group.Conclusion ：The shape and parameters of volume time curves and tissue Doppler Imaging can evalute left ventricular volume function and systolic synchronization.