实时三维超声心动图评价不同病因心力衰竭患者左心室收缩同步性的价值

Assessment of intra-left ventricular synchronism in patients with heart failure involved different pathogenesis by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)在评价心力衰竭患者左心室收缩同步性方面的应用价值。方法分别应用组织多普勒显像(tissue Doppler image,TDI)技术及RT-3DE对44例慢性心力衰竭患者(24例扩张型心肌病,20例缺血性心肌病)进行左心室收缩同步性分析,比较两种方法对不同病因心力衰竭患者左心室收缩同步性的评价结果,分析结果的一致性。结果TDI在24例扩张型心肌病患者中检出15例左心室收缩不同步,RT-3DE检出16例,TDI与RT-3DE均判定为左心室收缩不同步的患者有14例,Kappa值为0.727,P<0.01;TDI在20例缺血性心肌病患者中检出8例左心室收缩不同步,RT-3DE检出13例,TDI与RT-3DE均判定为左心室收缩不同步有6例,Kappa值为0.151,P>0.05。结论评价扩张型心肌病患者的左心室收缩同步性TDI与RT-3DE的一致性较好,评价缺血性心肌病患者的左心室收缩同步性两者一致性差。

Objectives To explore the value of real-time three-dimensional echocardiography （RT-3DE） in assessing intra-lefl ventricular synchronism in patients with chronic heart failure. Methods Ventricular synchronism analysis was conducted in 44 patients with chronic heart failure （24 of dilated cardiomyopathy and 20 of ischemic cardiomyopathy） by both tissue Doppler imaging （TDI） and RT-3DE. Results of assessing intra-left ventricular synchronism in patients with chronic heart failure of different pathogenesis and consistency of the two methods were analyzed and compared. Results Among the 24 patients suffering from dilated cardiomyopathy, 15 patients were asserted to have intra-lefl ventrieular dyssynchrony by TDI, and 16 were asserted by RT-3DE;14 patients were asserted to have intra-left ventricular dyssynchrony by TDI and RT-3DE simultaneously （Kappa value 0.727, P〈0.01 ）. While 8 of the 20 patients suffering from isehemic cardiomyopathy were asserted to have intra-left ventricular dyssynchrony by TDI, and 13 patients were asserted by RT-3DE ; 6 were asserted to have intra-left ventricular dyssynchrony by TDI and RT-3DE simuhaneously （Kappa value 0.151, P〉0.05）. Conclusions The consistency of TDI and RT-3DE in assessing intra-left ventricular synchronism among dilated cardiomyopathy patients is good, while it is poor among ischemic cardiomyopathy patients.