实时三维超声评价心肌梗死后左心室收缩功能及室壁运动同步性

Assessment of left ventricular systolic function and synchrony in patients after myocardial infarction by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图(RT-3DE)评价心肌梗死患者左心室收缩功能及同步性的应用价值。方法选取67例心肌梗死患者(心梗组)及61名健康志愿者(正常组)分别接受RT-3DE、M型超声及二维超声检查,心梗组分为3个亚组,A亚组:左冠状动脉狭窄(n=19)、B亚组:右冠状动脉狭窄(n=28),C亚组:多支病变(n=20)。分析比较3种方法所测以下参数:左心室整体、局部舒张末期容积(gEDV、rEDV),整体、局部收缩末期容积(gESV、rESV),整体、局部射血分数(gEF、rEF);左心室16节段从QRS波起点到最小收缩容积时间的标准差和最大差值(Tmsvl6-SD、Tmsvl6-Dif)。结果 M型超声、Simpson法所测的gEDV、gESV均高于RT-3DE(P均<0.05)。以gEF<55%作为判断收缩功能降低的截断点,M型超声、Simpson法、RT-3DE诊断心肌梗死的敏感度与特异度分别为96%和43%、98%和52%、98%和64%。RT-3DE局部心功能分析:与正常组对应节段比较,A亚组主要为前壁、前间隔,B亚组侧壁、下后壁、后间隔,C亚组绝大多数节段EDV、ESV增加,EF降低(P均<0.05)。心梗组Tmsvl6-SD、Tmsvl6-Dif、Tmsvl6-SD%、Tmsvl6-Dif%均大于正常组(P均<0.05)。结论 RT-3DE能更客观、准确地评价心肌梗死患者的收缩功能及室壁运动同步性,且能逐个节段进行局部定量分析,为临床提供更加全面可靠的参考信息。

Objective To explore the value of real-time three-dimensional echocardiography（RT-3DE）in evaluation of the left ventricular systolic function and motion synchronization in patients with myocardial infarction（MI）.Methods Totally 61 cases of healthy volunteers（normal group）and 67 patients with MI（MI group）underwent the RT-3DE,M-mode and two-dimensional echocardiography.The patients with MI were divided into three subgroups,i.e.left coronary artery stenosis（Subgroup A,n=19）,right coronary artery stenosis（Subgroup B,n=28）,multivessel lesions（Subgroup C,n=20）.The correlations and difference of the parameters measured by RT-3DE,M-mode and two-dimensional echocardiography were analyzed,including global and regional end-diastolic volume（gEDV,rEDV）,global and regional end-systolic volume（gESV,rESV）,global and regional ejection fraction（gEF,rEF）and the time to minimal systolic volume of 16-segmental＇standard deviation and mixmal difference（Tmsv16-SD,Tmsv16-Dif）.Results The gEDV,gESV estimated by RT-3DE was lower than that of M-mode and two-dimensional echocardiography（all P〈0.05）,Taking the EF55% as the cut-off value of systolic function abate,ROC curve analysis demonstrated a sensitivity of 96%,a specificity of 43%for M-mode,sensitivity of 98%,specificity of 52%for Simpson method,sensitivity of 98%,specificity of 64%for RT-3DE.RT-3DE could undertake the analysis of regional cardiac function,Subgroup A showed systolic function abate in segments mainly of anterior wall and anteroseptum,Subgroup B were in inferior wall and posterior wall,most segments of Subgroup C had the systolic function abate（all P〈0.05）.The parameters of wall motion synchronization（Tmsvl6-SD,Tmsvl6-Dif,Tmsvl6-SD%,Tmsvl6-Dif%）in MI group were all higher than that of normal group（all P〈0.05）.Conclusion RT-3DE can more objectively and accurately evaluate the systolic function and wall motion synchronization in patients with MI,and it can provide regional analysis to offer more comprehensive and reliable reference for clinical practice.