超声三维斑点追踪成像评价心脏再同步化治疗短期疗效的临床研究

Evaluation of Cardiac Resynchronization Therapy in Clinic by Threedimensional Speckle Tracking Imaging

目的探讨三维斑点追踪成像技术在评价心脏再同步化治疗(CRT)短期疗效中的临床应用价值。方法选择18例接受CRT的患者和20例正常人作为研究对象,对正常人,患者起搏器植入术前、术后1周、1月、3月分别进行常规超声检查及三维斑点追踪成像研究,测量左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)和左室射血分数(LVEF)。应用三维斑点追踪成像技术分析左心室功能及心肌运动同步性,超声参数包括左心室整体纵向应变(GLS)、左心室整体环向应变(GCS)、左心室整体径向应变(GRS)、左室16节段面积应变达峰时间最大差(A-Max-Ts)和标准差(A-Ts-SD)。结果与正常人比较,患者术前LVEDV、LVESV增大,LVEF、GLS、GCS、GRS减低,A-Max-Ts、A-Ts-SD延长。与术前比较,术后1周,GRS较术前稍有改善(P<0.05),其余参数差异无统计学意义(P>0.05);术后1月,LVEDV、LVESV明显减小(P<0.05);LVEF、GLS、GCS、GRS明显升高(P<0.05),A-Max-Ts、A-Ts-SD缩短(P<0.05)。术后1月与3月各参数差异无统计学意义。结论 CRT近期即可较明显改善心力衰竭患者的心功能。三维斑点追踪成像技术能有效观察左心室功能及心肌运动同步性的变化,可用于评价CRT治疗的效果。

Objective To study on evaluation of cardiac resynchronization therapy （CRT） in clinical by three- dimensional speckle tracking imaging. Methods Two-dimensional echocardiography and three-dimensional speckle tracking imaging examination were performed on 20 normal subjects and 18 congestive heart failure patients, who received the CRT, before implantation, one week, one month and three months after operation respectively. The left ventricular end-diastolic volume （LVEDV）, left ventricular contraction to the end of the volume （LVESV） and left ventficular ejection fraction （LVEF） were measured. And then, left ventficular function and myocardial movement synchronization were evaluated by three-dimensional speckle tracking imaging with ultrasonic parameters including left ventricular overall global longitudinal strain （GLS）, the left ventricle as a whole ring to the global circumferential .strain （GCS）, left ventricular overall global radial strain （GRS）, the area of the 16 segments of the left ventricular response time to peak maximum differential （A-Max-Ts） and standard deviation （A-Ts-SD）. Results In contrast to those in the normal, preoperative LVEDV and LVESV increased while LVEF, GLS, GCS and GRS decreased, A-Max-Ts and A-Ts-SD extended. Compared with those before CRT in the patients, GRS during postoperative one week slightly improved （P 〈0.05） though there wasn＇t any significant difference in the rest parameters （P〉 0.05）. At the end of the first month after CRT, LVEDV, LVESV were significantly reduced （P 〈0.05）, LVEF, GLS, GCS, GRS significantly increased （P 〈0.05）, A-Max-Ts, A-Ts-SD were shortened significantly （P 〈0.05）. There was no significant difference in all ultrasonic parameters between one and three months after CRT, Conclusion It＇s seemed to be certain that CRT could significantly improve cardiac function soon in patients with heart failure. Three- dimensional speckle tracking imaging could be used to detect left ventricular function and myocardial movement synchronization changes effectively and could be used to evaluate the short-term efficacy of CRT therapy.