三维斑点追踪成像对扩张型心肌病患者再同步化治疗后疗效的评价

Assessment of the effects of cardiac resynchronization therapy in patients with dilated cardiomyopathy by threedimensional speckle tracking imaging

目的 探讨三维斑点追踪成像（3D-STI）技术评价扩张型心肌病患者心脏再同步化治疗（CRT）后左心功能及心肌非同步运动变化的价值.方法 应用3D-STI对25例正常人及21例扩张型心肌病（DCM）患者行CRT术前后左心功能及心肌非同步运动指标进行检测,指标包括左室平均长轴应变（MLS）、平均圆周应变（MCS）、平均径向应变（MRS）、射血分数（3D-LVEF）及左室16节段面积应变达峰时间最大差（A-MaxTs）和标准差（A-Ts-SD）,并与放射性核素测量的左室射血分数（ECT-LVEF）及左心室相角程（LVW）进行相关分析.结果 与正常人比较,DCM患者MLS、MCS、MRS、3D-LVEF减低,AMaxTs、A-Ts-SD延长.CRT术后1周,DCM患者MRS、ECT-LVEF较术前稍有改善（P＜0.05）,其余参数较术前差异无统计学意义（P＞0.05）.术后6个月MLS、MCS、MRS、A-MaxTs、A-Ts-SD、3D-LVEF较术前及术后1周均有所改善（P＜0.05）.相关分析显示DCM患者MLS、MCS、MRS、3D-LVEF与ECTLVEF相关,A-MaxTs、A-Ts-SD与LVW相关.结论 3D-STI简便、准确,可用于评价DCM患者CRT后左心功能及心肌非同步运动的变化,为临床提供有价值参考.

Objective To evaluate the effects of cardiac resynchronization therapy （CRT） on improving left ventricle （LV） function and LV asynchrony in patients with dilated cardiomyopathy（DCM）using three-dimensional ultrasound speckle tracking imaging（3D-STI）.Methods Twenty one patients with DCM and 25 normal subjects were enrolled in this study.Parameters including LV mean longitudinal peak strain （MLS）,LV mean circumferential peak strain （MCS）,LV mean radial peak strain （MRS）,LV ejection fraction（3D-LVEF）,maximal temporal difference in area strain of LV 16 segments （A-MaxTs） and its standard deviation （A-Ts-SD） were investigated by 3D-STI.LV ejection fraction （ECT-LVEF） and LV phase angle width （LVW） were obtained by radionuclide ventriculography and phase image analysis.Results The indexes of MLS,MCS,MRS and 3D-LVEF were decreased and A-MaxTs,A-Ts-SD were prolonged in DCM group compared with those of control group.There was a slightly improvement in MRS and ECTLVEF 1 week after CRT,but other Parameters including MLS,MCS,A-MaxTs,A-Ts-SD and 3D-LVEF had no significant change.Compared with corresponding values before and 1 week after CRT,all parameters （MCS,MRS,A-MaxTs,A-Ts-SD,3D-LVEF and ECT-LVEF） were further improved 6 months after CRT.MLS,MCS,MRS and 3D-LVEF had good relationship with ECT-LVEF,and A-MaxTs,A-Ts-SD had good relationship with LVW in DCM group.Conclusions 3D-STI is a simple and accurate method for evaluating effects of CRT on improving LV function and LV asynchrony in patients with DCM.