不同QRS时限心力衰竭患者左心室收缩不同步的实时三维斑点追踪成像研究

Assessment of Left Ventricular Systolic Dyssynchrony by Real- time Three- dimensional Speckle Tracking Imaging in Patients with Chronic Heart Failure and Different QRS Duration

目的应用实时三维斑点追踪成像(RT-3DSTI)技术分析QRS时限增宽及正常的慢性心力衰竭(CHF)患者左心室收缩不同步性。方法研究对象包括CHF患者61例(其中31例QRS<120ms为CHF1组,30例QRS≥120ms为CHF2组)和正常对照组53例。分别进行RT-3DSTI分析,测量经心动周期标化的左心室16节段心内膜面积、径向、圆周及纵向应变达峰时间标准差(Tsas-SD%、Tsrs-SD%、Tscs-SD%及Tsls-SD%),分别计算左心室16节段中任意两节段心内膜面积、径向、圆周及纵向应变达峰时间的最大差值(Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff)。结果与对照组相比,CHF1和CHF2组的TsasSD%、Tsrs-SD%、Tscs-SD%、Tsls-SD%及Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff均增大,其中除CHF1组的Tsls-diff外,其余各项指标的测值与对照组比较均有统计学差异(P<0.01)。与CHF1组相比,CHF2组的心内膜面积、径向、圆周及纵向应变不同步指标均增大,差异均有统计学意义(P<0.05)。结论 QRS时限正常的慢性心力衰竭患者也存在左心肌收缩不同步,但程度轻于QRS时限增宽的心力衰竭患者。RT-3DSTI为临床准确评价心力衰竭患者心肌收缩不同步提供了一种新的有效方法。

Objective To assess the systolic dyssynchrony of left ventricular （LV） wall in patients with chronic heart failure（CHF）and different QRS duration by real-time three-dimensional speckle tracking imaging（RT-3DSTI）.Metbods The study included sixty-one patients with CHF,31 with QRS duration ＜ 120ms as CHF1 group and 30 with QRS duration≥ 120ms as CHF2 group,and 53 normal controls.The RT-3DSTI data sets obtained from all subjects were analyzed to evaluate LV dyssynchrony by the standard deviation of time from the onset of QRS complexes to peak systolic area,radial,circumferential and longitudinal strain for 16 segments related to heart cycle（Tsas-SD％,Tsrs-SD％,Tscs-SD％ and Tsls-SD％） as well as the maximal temporal difference for each of the components of the LV deformations in 16 segments（Tsas-diff,Tsrs-diff,Tscs-diff and Tsls-diff）.Results Compared with the controls,all of the systolic dyssynchrony indexes （Tsas-SD,Tsrs-SD,Tscs-SD,Tsls-SD,Tsas-diff,Tsrs-diff,Tscs-diff and Tsls-diff）in CHF1 group and CHF2 group increased,and except the Tsls-diff in CHF1 group,the rest of the indicators in CHF1 group and CHF2 group were significantly higher（P ＜ 0.0l）.Compared with CHF1 group,all of the systolic dyssynchrony indexes （Tsas-SD,Tsrs-SD,Tscs-SD,Tsls-SD,Tsas-diff,Tsrs-diff,Tscs-diff and Tsls-diff） in CHF2 group increased significantly（P ＜ 0.05）.Conclusion CHF patients with narrow QRS durations have LV systolic dyssynchrony,but the systolic dyssynchrony indexes were lower than in CHF patients with wide QRS durations.RT-3DSTI might offer a new rapid method to accurately evaluate LV systolic dyssynchrony.