实时三维超声定量分析冠心病患者的左室容积及运动同步性

Quantitative analysis left ventricular volume and synchronicity by real-time three-dimensional ultrasound for coronary heart disease patients

目的探讨应用实时三维超声心动图定量分析技术（3D Quantification Adcanced,3DQA）评价早期冠心病患者左室容积及运动同步性的变化。方法经冠状动脉造影（DSA）或CT血管造影（CTA）检查冠状动脉左前降支（LAD）狭窄的患者126例,按狭窄程度分成两组：Ⅰ组69例,狭窄率50%~75%;Ⅱ组57例,狭窄率76%~95%;对照组40例,无冠状动脉狭窄。分别应用二维Simpson法、三维超声检查,获得左室容积及射血分数参数,通过Q-Lab软件分析,获得同步性参数,比较组间各参数,并进行统计分析。结果各组间整体左室容积及射血分数差异无统计学意义。Ⅱ组LAD供血节段的舒张末容积、收缩末容积均增大,射血分数减小,同步性参数即各节段达最小收缩容积的时间的标准差（Tmsv-SD）和最大差（Tmsv-Dif）及经R-R间期校正后的标准差（Tmsv-SD%）和最大差（Tmsv-Dif%）与对照组、Ⅰ组比较均较延迟,差异有统计学意义（P〈0.05）;Ⅰ组上述参数与对照组比较,差异无统计学意义（P〉0.05）。结论 RT-3DE能够在左室整体容积及射血分数还未发生变化时,较早发现并定量评价左室收缩功能及节段运动同步性,对冠心病的早期诊断有重要价值。

Objective To evaluate left ventricular volume and the change of synchronization by using three-dimensional cardiac quantitative analysis technology in patients with early coronary artery disease（CAD）.Methods 126 patients confirmed various left anterior descending coronary artery（LAD） stenosis by coronary angiography（DSA） and CT angiography（CTA） were enrolled in this study.They were divided into two groups according to angiocardiography：group I including 69 patients with 50%-75% coronary artery stenosis,and group II including 57 patients with 76%-95% coronary artery stenosis.The control group including 40 healthy volunteers without coronary artery stenosis confirmed by DSA and CTA.Two-dimensional Simpson and three-dimensional ultrasound examination were respectively used to obtain the left ventricular volume and ejection fraction parameters,using the Q-Lab analysis software to get the synchronicity parameters,the parameters were compared and statistically analyzed.Results The whole left ventricular volume and ejection fraction differences among groups have no statistically significant.End-diastolic volume contraction and End systolic volume of LAD blood segmental in group Ⅱ were increased,the ejection fraction decreased,and synchronization parameters namely each segment of time of the standard deviation of the minimum contraction volume（Tmsv-SD） and the maximum difference（Tmsv-Dif） and R-R phase corrected standard deviation（Tmsv-SD %） and the maximum difference（Tmsv Dif-%） were delayed compared with control group and group I,the differences were statistically significant（P 〈0.05）.There was no statistically significant between group Ⅰ and control group on measurement parameters（P 〉0.05）.Conclusions RT-3 DE can early identify the change of left ventricular contractile function and segmental motion synchronization and quantitatively evaluate,it has important value for the early diagnosis of coronary heart disease.