超声对充血性心力衰竭患者再同步化治疗术后舒张功能改善的评价

Improvement of diastolic function in patients with congestive heart failure after cardiac resynchronization therapy by echocardiography

目的应用常规超声及组织多普勒成像技术（TDI）探讨充血性心力衰竭（CHF）患者再同步化治疗（CRT）后左室舒张功能变化。方法CHF患者31例，以CRT术后6个月左室收缩末容积降低≥10％为标准分为CRT有反应组（16例）和CRT无反应组（13例）。所有患者均于CRT术前1～3d、术后6个月接受超声检查。彩色M型超声测量二尖瓣口舒张期血流播散速度（Vp），计算E／Vp；TDI测量二尖瓣环四个位点的舒张早期运动速度（e），计算E／e；测量左室12节段心肌收缩期达峰时间（Ts—SD）、12节段Ts最大差值（Ts—Dif）。结果与CRT术前比较，CRT有反应组12节段Ts—SD、Ts—Dif均显著缩短，Vp显著增高，二尖瓣环各位点及4个位点平均E／e、E／Vp显著降低，而CRT无反应组上述参数均无显著差异；CRT有反应组二尖瓣环4个位点平均E／e、E／Vp与左室12节段Ts—SD呈显著正相关。结论CRT治疗有反应患者的左室舒张功能也得到改善，其机制可能与左室充盈压降低及左室松弛改善有关。

Objective To evaluate the diastolic function in patients with congestive heart failure （CHF） after cardiac resynchronization therapy （CRT） by conventional echocardiography or Doppler tissue imaging （TDI）. Methods 31 patients with CHF were divided into responders to CRT （group R） and nonresponders to CRT （group N） according the standard of a decline in left ventricular（LV） end-systolic volume≥10%. All the patients received echocardiography examination 1 - 3 days before CRT and 6 month after CRT. Color M-mode echocardiography indices included Vp, E/Vp. TDI indices included the peak velocity in early diastole （e） at 4 sites of mitral annulus,E/e,time to peak velocity in systole （Ts）,Ts-SD and maximum difference of Ts （Ts-Dif） among 12 segments. Results Compared with before CRT,Ts-SD and Ts-Dif significantly shortened in group R;Vp increased significantly,E/e at each 4 site and mean value at 4 sites of mitral annulus, E/Vp decreased significantly; but there were no significant difference in group N. There were significant positive correlation between mean value at 4 sites of E/e, E/Vp and Ts-SD in group R. Conclusions The diastolic function in responders to CRT improved after CRT, which was associated with the decreased LV filling pressure and improved LV relaxation.