药物干预对扩张型心肌病患儿心室非同步化运动的影响

Effect of Drug Intervention on Ventricular Asynchrony in Children with Dilated Cardiomyopathy

目的利用超声心动图实时三平面显像技术探讨儿童扩张型心肌病（DCM）心室非同步化运动特点及药物治疗效果。方法 DCM患儿19例,均给予药物治疗并随访。用M型超声心动图测定其左心室收缩末期内径、左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积、左心室射血分数。应用GE Vivid 7三平面显像技术同步获取其心尖四腔、左心室两腔和左心室长轴切面的三平面组织同步成像,收缩达峰时间（Ts）在60～150 ms者自动编码呈绿色、150～300 ms编码呈黄色和橙色、300～500 ms编码呈红色。测定其后间隔、侧壁、下壁、前壁、后壁及前间隔的基底段和中间段Ts,计算Ts的标准差（Ts-SD）。比较DCM药物治疗前、后左心室组织同步成像图特点、Ts及Ts-SD。结果 DCM左心室部分节段在药物治疗后心肌颜色由红色转变成橙色或由橙色转变成黄色,虽然左心室Ts-SD有所增加,由治疗前的（52.90±29.60）ms增加到治疗后的（69.00±37.55）ms（P〉0.05）,但多数节段Ts呈降低趋势（P〉0.05）。结论儿童DCM普遍存在左心室非同步收缩,药物治疗可能有改善DCM儿童左心室非同步收缩的趋势。

Objective To investigate the feature of ventricular asynchrony and effect of drug intervention on children with dilated cardiomyopathy（DCM） by echocardiographic tri-plane imaging.Methods Nineteen children with DCM hospitalized in Children′s Hospital of Chongqing Medical University were included in this study.All children with DCM were given medication and followed up.The left ventricular end-systolic dimension,left ventricular end-diastolic dimension,left ventricular end-diastolic volume,left ventricular end-systolic volume and left ventricular ejection fraction were measured with M-echocardiography.The triplane tissue synchronization imaging（TSI） of apical four-chamber,apical two-chamber and apical long-axis views was obtained simultaneously by real-time three-dimensional echocardiography of GE Vivid 7 ultrasound imaging system.The intervals from R-wave to peak systolic tissue velocity（Ts） were automatically transformed into various colors coding depending on the severity of delay in the Tri-plane TSI images,in the sequence of green（Ts was 60-150 ms）,yellow and orange（Ts was 150-300 ms）,red（Ts was 300-500 ms）.The Ts at both basal and middle levels of septal,lateral,inferior,anterior,post and anterior-septal of left ventricular were measured.For the assessment of systolic asynchrony,standard deviations of Ts of the 12 segments（Ts-SD）in left ventricular were calculated.The TSI images and Ts,Ts-SD were analyzed before and after medical therapy.Results The colors of some segments were improved from red to orange or from orange to yellow after medical therapy.The Ts value at most of the segments decreased after therapy,but the difference was not significant（P0.05）,though the Ts-SD increased from（52.90±29.60） ms before treatment to（69.00±37.55） ms after treatment,but there was no significant difference（P0.05）.Conclusions Systolic asynchrony of left ventricular in children with DCM presented frequently,and there was a tendency that systolic asynchrony of left ventricular in children with DCM could be improved through medical therapy.