三维超声斑点追踪成像技术评价左室局部收缩功能的初步临床研究

Primary study of three-dimensional speckle tracking imaging in assessment of left ventricular regional systolic function

目的探讨基于二维超声斑点追踪成像(2DSTI)与实时三维超声心动图的三维超声斑点追踪成像(3DSTI)新技术评价左室心肌局部收缩功能的可行性。方法随机选取心脏超声检查的受检者42例。采集其标准的3个左室短轴观动态图及心尖四腔观左室全容积图像,并存储。应用2DSTI和3DSTI技术分别测量左室瓣环水平(B)、乳头肌水平(M)和心尖水平(A)16节段的径向与环向收缩期应变峰值,并进行比较;分析2DSTI和3DSTI的相关性。结果①3DSTI测定的B水平下壁、侧壁和后间隔,M水平下壁及A水平前壁5个节段的收缩期径向应变峰值较2DSTI测值偏低(均P<0.05),其余11节段3DSTI的测值与2DSTI比较差异无统计学意义(均P>0.05)。②在环向方向上,3DSTI测定的B水平下壁、后壁和前间隔,M水平后侧壁、前壁5个节段的环向应变峰值较2DSTI测值偏低,差异有统计学意义(均P<0.05),其余11节段3DSTI测值与2DSTI测值比较差异无统计学意义(均P>0.05)。③分别应用3DSTI与2DSTI技术测定的各节段径向峰值应变与环向应变峰值,相关性良好(r=0.667～0.955,均P<0.05)。④2DSTI和3DSTI技术的应变测值在观察者间及观察者内比较均具有较好一致性。结论 3DSTI新技术能实时追踪三维空间上心肌运动轨迹,定量测量左室局部心肌纤维的形变特征,有望成为临床评价心肌收缩功能的新方法。

Objective To evaluate the feasibility of three-dimensional speckle tracking imaging（3DSTI） that based on two-dimensional speckle tracking imaging （2DSTI） and real-time three dimensional echocardiography in assessment of left ventricular （LV） regional myocardium function. Methods Forty-two subjects were examined by echocardiography, the short axis views of left ventricle were aquired and real-time 3D full volume datasets on apical four- chamber view were obtained. Peak radial strain （PRS） and peak circumferential strain （PCS） in 16 segments of left ventricular circular level（ B）, papillary muscle level （M） and apical level （A） were measured by 2DSTI and 3DSTI, the results were compared, and their relationship was analyzed. Results PRS on inferior, lateral wall and posterior septum of B level , inferior wal lof M level and anterior wall of A level measured by 3DSTI were lower than those measured by 2DSTI （ all P〈0. 05 ） , there was no significant difference of the rest 11 segments by 2DSTI and 3DSTI （ all P〉0.05 ）. PCS on inferior, posterior wall and anterior septum of B level, posterior lateral and anterior wall of M level measured by 3DST were lower than those by 2DSTI, there was significant difference （all P〈0.05 ）, there was no significant difference of the rest 11 segments by 2DSTI and 3DSTI （all P〉0. 05 ）. PRS and PCS measured by 2DSTI and 3DSTI had good correlation （r= 0. 667 - 0. 955, all P〈0.05 ）. （4）Peak strain mesured by 2DSTI and 3DSTI showed high inter- and intraobserver agreement. Conclusion 3DSTI is a novel technique in evaluating regional systolic function of left ventricle, and provides a new means to quantitatively assess the left ventricular systolic function.