斑点追踪成像技术在慢性心力衰竭药物疗效评价中的应用

Application of Speckle Tracking Imaging in the Evaluation of Chronic Heart Failure

目的：以琥珀酸美托洛尔缓释片为例,探索斑点追踪成像技术在慢性心力衰竭（CHF）药物疗效评价中的价值。方法：68例既往未接受正规治疗的CHF患者,均予以琥珀酸美托洛尔缓释片及常规抗心力衰竭药物治疗3个月。治疗前与治疗后1、3月分别记录患者纽约心脏病协会（NYHA）心功能分级、静息心率（RHR）、6 min步行距离（6MWD）及常规心脏超声测定值,存取心尖四腔心、两腔心及左室长轴切面动态图像进行斑点追踪脱机分析,测定左室整体纵向应变（LVGLS）。治疗3个月后,依据RHR将CHF患者分为达标组（A组,RHR为55~60次/min）与未达标组（B组,RHR〉60次/min）,比较两组患者上述各项指标治疗后的改善情况,同时比较LVGLS的改善情况。结果：组间比较,治疗1个月时A组较B组患者的RHR、左室舒张末前后径、左室射血分数（LVEF）、LVGLS显著改善,差异均有统计学意义（P〈0.05）;治疗3个月时,两组患者各项指标比较差异均有统计学意义（P〈0.05）。A组组内比较,治疗1个月时RHR、6MWD、LVGLS显著改善,与治疗前比较差异有统计学意义（P〈0.05）;治疗3个月与治疗前及治疗1个月时比较,各项指标差异均有统计学意义（P〈0.05）。B组组内比较,治疗1个月时RHR、6MWD有显著改善,与治疗前比较差异有统计学意义（P〈0.05）;治疗3个月与治疗前比较各项指标均有明显改善,差异有统计学意义（P〈0.05）,但与治疗1个月时比较,仅RHR与NYHA分级差异有统计学意义（P〈0.05）。结论：斑点追踪成像技术可早期反映CHF患者抗心力衰竭治疗后心功能的改善情况,尤其是在RHR控制达标者中能更早更显著地反映。该技术同常规心功能评价指标一样,在随访抗心力衰竭疗效评价中具有良好的临床应用价值。

OBJECTIVE：Taking metoprolol succinate sustained-release tablets as an example,to explore the value of speckle tracking imaging in therapeutic efficacy evaluation of CHF drugs. METHODS：68 CHF patients who had never underwent regular treatment were given Metoprolol succinate sustained-release tablets and anti-heart failure agents for 3 months. NYHA classification,resting heart rate（RHR）,6 min walk distance（6MWD）and conventional echocardiographic measurements were tested before and1 and 3 months after treatment. Dynamic image were collected in the apical 2-chamber view,apical 4-chamber view and left ventricular long axis plane for speckle tracking imaging offline analysis. The left ventricular global longitudinal strain（LVGLS）were measured. After 3 months of treatment,CHF patients were divided into standard group（group A,RHR 55-60 times/min）and nonstandard group（group B,RHR60 times/min） according to resting heart rate. The improvement of above indicators were compared between 2 groups,and that of LVGLS was also compared. RESULTS：After 1 month of treatment,RHR,LVEDd,LVEF and LVGLS of group A were improved significantly,compared with group B,with statistical significance（P0.05）. After 3months of treatment,there was statistical significance in above indicators between 2 groups（P0.05）. In group A,RHR,6MWD and LVGLS improved significantly after 1 month of treatment,there was statistical significance,compared with before treatment（P0.05）;there was statistical significance in above indicators after 3 months of treatment,compared with before treatment and after 1 month of treatment（P0.05）. In group B,RHR and 6MWD improved significantly after one month of treatment;there was statistical significance,compared with before treatment（P0.05）;there was statistical significance in significant improvement of each indicator between after 3 months of treatment and before treatment（P0.05）;only there were statistical significance in RHR and NYHA grading,compared with after one month of treatment（P0.05）. CONCLUSIONS：Speckle tracking imaging can early reflect the left ventricular function improvement of CHF patients after anti-heart failure treatment,especially in patients with RHR control standard earlier and more significant. Speckle tracking had good clinical application value in the follow-up treatment of heart failure as routine evaluation index.