实时三维超声心动图和二维斑点追踪对冠心病患者左心室整体收缩功能与同步性的评价

Assessment of left ventricular systolic function and synchrony using realtime three-dimensional echocardiolograph and two-dimensional speckle tracking imaging in patients with coronary heart disease

目的探讨实时三维超声心动图(RT-3DE)和二维斑点追踪显像(2D-STI)评价心肌缺血和心肌梗死患者左室整体收缩功能和同步性的临床应用价值,及两种方法在评价左室收缩同步性方面的相关性。方法 46例心肌缺血患者(心肌缺血组)、44例心肌梗死患者(心肌梗死组)和60例健康志愿者(正常对照组)行RT-3DE和2D-STI检查,应用Qlab8.1软件脱机分析,获得左心室收缩功能参数:GLS、GCS、GRS、3D-LVEDV、3D-LVESV和3D-LVEF;同步性参数:Tls-l6-SD、Trs-l2-SD、Tcs-l2-SD、TAS-POST、Tmsv-l6-SD和Tmsv-16-Dif。结果与正常对照组比较,心肌缺血组常规超声心动图无阳性发现,2D-STI示GLS明显降低,Tls-16-SD明显延长(P<0.05);RT-3DE"牛眼图"可见室壁运动异常的节段,Tmsv-16-SD、Tmsv-16-Dif明显延长(P<0.05)。心肌梗死组常规超声心动图、2D-STI及RT-3DE均有阳性表现,RT-3DE与2D-STI同步性参数相关性分析示Tmsv-16-SD与TAS-POST呈正相关(r=0.574,P<0.01),其余参数无相关性。结论 RT-3DE与2D-STI可早期客观评价心肌缺血组冠心病患者左室收缩同步性,且二者存在一定相关性。

AIM To assess the clinical value of real-time three-dimensional echocardiolography （RT- 3DE） and two-dimensional speckle tracking imaging （2D-STI） in evaluating left ventricular （LV） global systolic function and synchrony in patients with myocardial ischemia and myocardial infarction and to investigate the correlation of the two techniques in left ventricular synehrony. METHODS RT-3DE and 2D-STI were performed in 46 patients with myocardial isehemia, 44 patients with myocardial infarction and 60 healthy subjects （ control group）. Offline analysis was conducted using Qlab 8.1 to measure or calculate the parameters of systolic function （GLS, GCS, GRS, 3D-LVEDV, 3D-LVESV, 3D-LVEF） and synchrony （TIs-16-SD, Trs-12-SD, Tcs-12-SD, TAS-POST, Tmsv-16-SD, Tmsv-16-Dif）. RESULTS Compared with those in the control group, no positive manifestations were found using conventional echocardiography in myocardial isehemia group. GLS significantly decreased, TIs-16-SD was significantly prolonged measured by 2D-STI （P 〈 0. 05）, Tmsv-16-SD and Tmsv-16-Dif significantly increased measured by RT-3DE （P 〈0. 05） and left ventricle regional abnormal wall motion was displayed in the bull＇s- eye map of RT-3DE. Compared with those in the myocardial ischemia group and control group, conventional eehocardiography, 2D-STI and RT-3DE, respectively, had positive manifestations in myocardial infarction group. Tmsv-16-SD and TAS-POST were positively correlated （ r = 0. 574, P 〈 0. 01 ） but no correlation was found in other synchrony parameters. CONCLUSION 2D-STI and RT-3DE can early assess LV systolic synchrony in patients with myocardial ischemia. Tmsv-16-SD and TAS-POST are positively correlated.