实时三维超声心动图评价左室收缩功能及同步性与心电活动的关系

The Relationship between Left Ventricular Systolic Function and Synchronicity with Electrical Activity Assessed by Real-Time Three-Dimensional Echocardiography

目的应用实时三维超声心动图评价不同患者左室收缩功能及收缩同步性的价值,探讨不同步性与心电活动的关系。资料与方法应用GEViVid7.0采集40例心衰患者(A组)、40例心衰高危因素患者(B组)和30例健康志愿者(C组)的左室全容积图像。采用左室16节段时间-容积曲线分析后,计算左室16节段、12节段达到最小收缩容积的时间(Tmsv)的标准差(SD)和最大差值(Dif):即Tmsvl6-SD、Tmsvl6-Dif、Tmsv12-SD、Tmsv12-Dif;获取左室舒张末容积(LVEDV)、收缩末容积(LVESV)、左室射血分数(LVEF)。常规体表心电图获取P-R间期、QRS波宽度。结果①A、B两组LVEDV、LVESV、LVEF及收缩不同步性指标与C组各组间比较,差异均有显著性意义(P<0.05);②A组LVEF与收缩不同步性指标有良好的负相关性,以Tmsvl6-SD%相关性最高,(r=-0.721,P<0.001);Tmsvl6-SD%与QRS宽度呈弱相关(r=0.314,P=0.049),并且有27.5%的患者QRS<120ms,但存在左室机械不同步;③B组Tmsvl6-SD%与LVEF、QRS宽度之间无相关性。结论实时三维超声心动图能真实反映左室收缩功能及收缩同步性,能客观揭示机械不同步性与心电活动的关系,为慢性心力衰竭的防治提供简便、有效、可靠的依据。

Purpose To evaluate the left ventricular systolic function and systolic synchronicity in different patients using real-time three-dimensional echocardiography, and to discuss the relationship between mechanical asynchrony and electrical activity. Materials and Methods Forty patients with chronic heart failure were referred as group A, forty patients with high risk factors of heart failure were referred as group B, and thirty healthy volunteers were referred as group C. Full volume RT-3DE was performed by using GE ViVid 7 with X3-1 probe. The 16-segmental time-volume curves were obtained by the off-line Tom Tec software 4D LV -Analysis system. The time-to-minimal-systolic-volume （Tmsv） in each segment was taken to derive the following indexes of systolic asynchrony： Tmsvl6-SD, Tmsvl6-Dif, Tmsvl2-SD, Tmsvl2-Dif, and the end-systolic volume （LVESV）, end-diastolic volume （LVEDV）, left ventricular ejection fraction （LVEF） were derived. Conventional surface electrocardiogram was used to obtain P-R interval and the wave width of QRS duration. All parameters were dealt with statistics. Results （1） LVEDV, LVESV, LVEF and systolic asynchrony of Group A and Group B were significantly different, compared with group C （P〈0.05）. （2） There were significantly negative correlation between LVEF and the systolic synchrony parameters in group A, especially Tmsv 16-SD% （r=-43.721,P〈 0.001）, a weak relation was found between LVEF and QRS duration （r=0.314,P=-0.049）, and 27.5% of patients with QRS〈 120ms and exhibit of left ventricular asynchrony.（3） There were no significant relation between Tmsvl6-SD% and LVEF, QRS duration in group B. Conclusion The real-time three-dimensional echocardiography and quantitative analysis software can reflect left ventricular systolic function and systolic synchronism. It can objectively reveal the correlation between mechanical asynchrony and electrical activity, and provide the convenient, effective, reliable evidence for the early prevention and treatment of chronic heart failure.