实时三维超声心动图评价心力衰竭患者左室重构与收缩同步性的临床研究

Clinical Research of the Left Ventricular Remodeling and Systolic Dyssynchrony by Real-time Three-dimentional Echocardiography in the Patients with Heart Failure

目的应用实时三维超声心动图(RT-3DE)分析评价不同程度心力衰竭(HF)患者左室重构指数(LVRI)与收缩不同步参数。方法随机收集80例各种病因所致HF患者和32例正常人,HF患者根据严重程度分为A、B、C 3组。均给予RT-3DE检查并获取下列参数:左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)及左室舒张末期质量(LVM)、左室重构指数(LVRI)。收缩不同步参数包括:①各节段达到收缩期收缩峰值的平均时间(平均3D-Ts);②心率校正后16节段收缩期不同步峰值的标准差(Tmsv-16sd/RR,SDI);③16节段收缩达最小容积时间的最大时间差(Tmsv16-dif)。比较各组间参数差异及LVRI与不同步参数的相关性。结果与对照组相比,HF各组随程度加重所有参数均呈上升趋势,尤以中重度B、C两组显著。相关性分析显示,HF各组LVRI与不同步参数均呈正相关,在重度HF C组,LVRI与平均3D-Ts、SDI呈显著正相关,相关系数分别为:0.76,0.82。结论 HF患者可出现不同程度的左室重构及收缩不同步,LVRI与收缩不同步呈明显相关,且相关性随心力衰竭程度加重呈升高趋势。LVRI在一定程度上可以反映左室收缩的不同步情况。

Objective To evaluate the left ventricular remodelling index（LVRI） and systolic dyssynchrony by real - time three - di- mentional echocardiography （ RT - 3DE） in the patients with heart failure（HF）. Methods 80 patients with heart failure （HF） for differ- ent causes and 32 normal subjects were collected. Patients with HF were divided into three groups according to the severity of heart failure （group A, group B and group C, respectively）. Data of 80 patients with HF were acquired by RT- 3DE. The left ventricular end -dias- tolic volume（LVEDV） , left ventrieular end- systolic volume（LVESV） and the left ventricular end -diastolic mass（ LVM ） were meas- ured and the LVRI were calculated. Parameters for evaluating systolic dissychrony included the average time to maximum systolic amplitude of all segments （ average 3D - TS） , the time to minimum systolic volume of 16 - segmental standard deviation as a ratio of R - R interval （Tmsvl6 - sd /RR, SDI） , the time to minimal systolic volume of 16 - segmental maximal difference （Tmsvl 6 - Dif）. All the parameters were compared between groups, then the correlation analysis between LVRI and all the dyssynchrony parameters in each group were fin- ished respectively. Results Compared with the normal group,all the parameters increased in different HF groups, especially in group B and group C. Analysis showed that LVR1 had positive correlations with dyssynchrony parameters in all the HF groups. In group C, the correlation coefficients between LVRI and average 3D - TS, SDI were O. 76, 0.82, respectively. Conclution Left ventricular remodeling and dyssynchrony occurred in HF patients. There was well correlation between LVRI and dyssynehrony parameters in the patients with HF. To some extent, the LVRI could evaluate the severity of LV systolic dyssynchrony.