实时三维超声心动图优化CRT心室起搏

The role of realtime three-dimensional echocardiography in cardiac resynchronization therapy patients’ VV optimization

目的探讨利用实时三维超声心动图(RT3DE)评价左心功能和室壁运动同步性在双心室优化起搏过程中即刻的变化,以指导心脏再同步化治疗患者VV间期优化起搏。方法选择接受CRT治疗的心力衰竭患者32例,术前采用RT3DE检测左室16个心肌节段达收缩末最小容积时间的差值(Tmsv16-Dif)和心率标化后的标准差(Tmsv16-SD/R-R)作为同步性参数,与即刻的主动脉速度时间积分(VTIAV)进行比较,同时测量左室舒张末及收缩末容积(LVEDV,LVESV)和射血分数(LVEF)作为左心功能参数,与常规二维超声Simpson双平面法及M型超声Teich法测量左室射血分数(LVEF)评价左心功能比较,1月后行VV间期优化,优化前及每个VV间期均采集术前相同数据,每调整一次双室起搏顺序后10min后同术前相同采集图像。对上述三维及常规参数定量分析比较。结果优化VV间期后与优化前比较,RT3DE所测室壁运动同步化指标包括Tmsv16-Dif,Tmsv16-SD%(R-R)有明显改善,与VTIAV成负相关。结论 RT3DE能更精确、更方便地评价左室收缩同步性和收缩功能,且能即刻反映相关变化趋势,在双心室优化起搏治疗重度充血性心力衰竭中发挥其应有的作用。

Objective To evaluate realtime three-dimensional echocardiography （RT3DE） measured left heart function and room wall motion synchronicity in the double ventricular pacing optimization process of the immediate changes, in order to guide cardiac resynchronization therapy patients VV pacing optimization. Methods 32 cases accepted CRT were enrolled, preoperative using RT3DE detected the standard deviation of the minimal systolic volume time in 16 segments （Tmsv16-Dif） and heart rate after the standardized the standard deviation （Tmsv16-SD/R-R） as synchronicity parameters, compared with left ventricular 12 segment electric machinery delay time of standard deviation on TVI mode and velocity time integral （VTI） on aortic orifice which evaluate left ventricular synchronicity. simultaneous measurement of left ventricular end-diastolic volume and end-systolic volume （LVEDV, LVESV） and ejection fraction （LVEF） as a left heart function parameters, compared with the normal two-dimensional ultrasound Simpson double plane method and M type ultrasonic TICH method for measuring the left ventricular ejection fraction （LVEF） evaluate left heart function, optimized VV interval one month later, collect the same preoperative date, acquisition images after adjust each order of double room pacing after 10 minutes, quantitative analysis and compared the above three dimensional echocardiographic parameters ahd the routine parameters. Results RT3DE measuring room wall movement synchronization index includes Tmsv16-Dif, Tmsv16-SD, which a negative correlation with aortic VTI, correlation is obviously superior to the Ts12-SD on TVI and LVEDd, RT3DE measured left ventricular systolic function index LVEF with aortic VTI into positive correlation, LVESV a negative correlation with the aorta VTI, The correlation has better than Simpson method and TICH method measure LVEF. Conclusions RT3DE can accurately and conveniently evaluation left ventricular systolic function and contraction synchronicity, and can immediately reflect the change trend of the related, to play an important role in the double ventricular pacing optimization for severe congestive heart failure.