平衡法核素心室显像评价心力衰竭患者的心脏收缩同步性

Contractile Synchrony in Patients with Heart Failure:Assessment by Equilibrium Radionulide Angiography

目的应用平衡法核素心室显像评价心力衰竭发生、发展过程中心脏收缩同步性的变化规律。资料与方法将206例心力衰竭患者按心力衰竭发生、发展过程的4个阶段分成高发危险因素阶段组(A)、器质性心脏病阶段组(B)、症状性心力衰竭阶段组(C)、难治性心力衰竭阶段组(D),并纳入30例健康体检者作为对照。采用平衡法核素心室显像测量并比较各组室间收缩延迟(IVCD)、左心室相角程宽(LVPSW)和左心室位相角标准差(LVPSD)。结果室间同步性:A、B、C、D组IVCD均明显高于对照组(t=-2.02、-2.23、-2.38、-3.20,P<0.05)。随着心力衰竭发生、发展过程的进展,IVCD逐渐增高,B、C、D组IVCD显著高于A组(q=2.24、2.95、3.07,P<0.05),但B组与C组、B组与D组、C组与D组间IVCD差异无统计学意义(q=0.44、0.50、0.28,P>0.05)。室内同步性:A、B、C、D组LVPSW均明显高于对照组(t=-2.79、-5.43、-8.27、-9.46,P<0.05)。B、C、D组LVPSW明显高于A组(q=2.83、4.86、5.09,P<0.05)。C、D组LVPSW明显高于B组(q=3.10、3.37,P<0.05)。从A组到D组,LVPSW逐渐增加。B、C、D组LVPSD均明显高于对照组(t=-3.31、-5.02、-5.35,P<0.05)。从B组到D组,LVPSD逐渐增高。结论心力衰竭患者从A阶段开始出现室间、室内收缩不同步。从A阶段发展到D阶段,左心室内收缩同步性逐渐变差。

Purpose To observe contractile synchrony in patients with heart lhilure at different stages by equilibrium radionulide angiography. Materials and Methods A total of 206 patients with heart failure were enrolled as experimental group, and further divided into group A （with heart failure at high risk）, group B （with organic heart diseases）, group C （with symptorns of heart failure）, and group D （with refractory heart failure） in terms of the development of heart failure. 30 healthy people were also included as controls. Then indicators like interventricular contractile delay （IVCD）, left ventricular phase shift width （LVPSW） and left ventricular phase standard deviation （LVPSD） were measured by equilibrium radionulide angiography and compared among groups. Results lnterventricular synchronization： IVCD in group A, B, C and D was significantly higher than that in control group （t=-2.02, -2.23, -2.38, -3.20, P〈0.05）, and had a trend of gradual increase with the development of heart failure, which was proved by the evidence that IVCD in group B, C and D was significantly higher than that in group A （q-2.24, 2.95, 3.07, P〈0.05）. However, there was no statistical difference among group B, C and D （q=0.44, 0.50, 0.28, P〉0.05）. lntraventricular synchronization： LVPSW in group A, B, C and D was significantly higher than that in control group （t=2.79, -5.43, -8.27, - 9.46, P〈0.05）. LVPSW in group B, C, and D was statistically higher than that in group A （q=2.83, 4.86, 5.09, P〈0.05）, LVPSW in group C and D was significantly higher than group B （q=3.10, 3.37, P〈0.05）, and it had an increase from group A to group D. LVPSD in group B, C and D was significantly higher than that in control group （t= - 3.31, - 5.02, -5.35, P〈0.05）, and it increased from group B to group D. Conclusion Interventricular and intraventricular asynchrony emerges in the early stage of heart failure and deteriorates as heart failure develops.