超声评价慢性充血性心力衰竭患者心脏再同步化治疗术后舒张功能及其与同步性的关系

Relationship between diastolic function and synchronism in patients with congestive heart failure after cardiac resynchronization therapy evaluated by echocardiography

目的应用常规超声及组织多普勒成像(TDI)技术评价慢性充血性心力衰竭(CHF)患者经心脏再同步化治疗(CRT)后左室同步性及舒张功能变化,以及二者间的关系。方法 CHF组患者44例,均于CRT术前1～3d、术后6个月接受超声检查。常规超声测量参数:左室舒张末内径(LVEDd)、LVESV、左室舒张末容积(LVEDV)、左室射血分数(LVEF)、二尖瓣口舒张早、晚期血流速度比值(E/A);TDI测量参数:二尖瓣口舒张早期血流速度与二尖瓣环舒张早期运动速度比值(E/e)、左室12节段收缩期达峰时间标准差(Ts-SD)、左室12节段收缩期达峰时间最大差值(Ts-dif);计算CRT术前后二尖瓣环平均E/e变化率(ΔE/e%)和Ts-SD变化率(ΔTs-SD%)。结果最终纳入研究41例,根据CRT术后6个月左室收缩末容积(LVESV)降低≥10%的标准将其分为CRT有反应组24例和CRT无反应组17例。与CRT术后比较,CRT有反应组患者CRT术后6个月LVEDd、LVEDV、LVESV显著减小,LVEF、E/A显著增加,E/e显著降低,Ts-SD、Ts-dif显著缩短;而CRT无反应组患者上述参数差异均无统计学意义。CRT有反应组患者CRT术前后ΔE/e%与ΔTs-SD%呈正相关(r=0.68,P<0.05)。结论 CRT术后有反应患者的左室同步性及舒张功能均得到改善,其左室舒张功能改善的机制可能与同步性改善后降低的左室充盈压有关。

Objective To evaluate the diastolic function and relationship between diastolic function and synchronism in patients with congestive heart failure （CHF） after cardiac resynchronization therapy（CRT） by echocardiography. Methods Forty-four patients with CHF. received echocardiography examination 1-3 d before CRT and 6 month after CRT. Conventional indices included LVDEd, LVESV, LVEDV, LVEF and E/A. TDI indices included E/e, Ts-SD, Ts-dif, △E/e% and △Ts-SD%. Results Forty-one patients were enrolled in this study, they were divided into responders to CRT and non-responders to CRT groups according the standard of a decline in LV end-systolic volume ≥ 10% .Compared with before CRT, LVEDd, LVEDV and LVESV were significantly decreased, LVEF, E/A were significantly increased, E/e was significantly decreased,Ts-SD,Ts-dif were significantly shortened in responders 6 months after CRT; but there was no significant difference in non-responders. There was significant positive correlation between AE/e% and ATs-SD% in responders. Conclusion The LV synchronism and diastolic function in responders are improved after CRT. The improved diastolic function is associated with the decreased LV filling pressure.