实时三维超声心动图评价冠状动脉狭窄患者左心室收缩功能与同步性

Evaluation of left ventricular systolic function and synchrony in patients with coronary artery stenosis by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图（RT-3DE）评价冠状动脉狭窄患者左心室收缩功能与同步性的临床应用价值。方法收集经冠状动脉造影证实左前降支（LAD）狭窄的患者50例,按狭窄程度分成Ⅰ组21例,狭窄率50%~75%;Ⅱ组29例,狭窄率≥76%。另选正常对照组60例,LAD无狭窄。所有患者均接受RT-3DE检查,通过脱机分析左心室17节段的容积-时间曲线,获取左心室整体收缩同步性参数（Tmsv-16-SD、Tmsv-16-SD%、Tmsv-16-Dif、Tmsv-16-Dif%）、LAD供血节段收缩功能参数（rEDV、rESV、rEF）及节段同步性参数（Tmsv%）。结果对照组节段射血分数（rEF）自基底段至心尖段逐渐增大,自基底段至中间段的差异有统计学意义（P〈0.05）,而自中间段至心尖段差异无统计学意义（P〉0.05）,Ⅰ组、Ⅱ组上述演变规律消失。Ⅱ组患者rEDV、rESV均明显增大,Tmsv-16-SD、Tmsv-16-SD%、Tmsv-16-Dif、Tmsv-16-Dif%、Tmsv%均明显延长,rEF明显降低（P均〈0.05）,Ⅰ组患者上述各参数与对照组比较差异无统计学意义（P均〉0.05）。结论 RT-3DE可早期定量评价LAD不同程度狭窄患者左心室节段性收缩功能及收缩同步性的变化。

Objective To evaluate left ventricular systolic function and synchrony in patients with coronary artery stenosis by real-time three-dimensional echocardiography（RT-3DE）.Methods Fifty patients with different degrees of left anterior descending（LAD）stenosis were divided into 2groups according to angiocardiography：GroupⅠincluding 21 patients with50%—75% LAD coronary artery stenosis,groupⅡincluding 29 patients with≥76% LAD coronary artery stenosis.Sixty subjects were in control group with no coronary stenosis.All patients were measured by RT-3DE.The 17-segmental volume-time curves of left ventricular were plotted,the global synchrony parameters（Tmsv-16-SD,Tmsv-16-SD%,Tmsv-16-Dif,Tmsv-16-Dif%）were obtained,meanwhile the regional systolic function parameters（rEDV,rESV,rEF）and synchrony parameter（Tmsv%）were required.Results The rEF of every segment in control group increased in a smooth progression from base to apex,there was significant statistical difference from base to middle（P〈0.05）,but there was no statistical difference from middle to apex（P〉0.05）;the rEF of every segment in group Ⅰ and group Ⅱlost the above regulation.rEDV and rESV increased significantly,rEF decreased obviously,Tmsv-16-SD,Tmsv-16-SD%,Tmsv-16-Dif,Tmsv-16-Dif% and Tmsv% were delayed significantly（all P〉0.05）in groupⅡ.The parameters between group I and control group had no significant differences（all P〉0.05）.Conclusion RT-3DE can early quantitatively assess the changes of left ventricular regional systolic function and systolic synchrony in patients with different degree stenosis of LAD.