二维斑点追踪技术联合实时三维超声心动图评价尿毒症心肌病左心室收缩功能及其同步性

Evaluation of left ventricular systolic function and synchrony in patients with uremic myocardiopathy using two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography

目的:联合应用二维斑点追踪技术(two-dimensional speckle tracking imaging,2DSTI)与实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价尿毒症心肌病(uremic myocardiopathy,UM)患者左心室收缩功能与同步性。方法:对33例UM患者及35例健康体检者行常规超声心动图检查,采用M型超声测量左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、室间隔厚度(IVSd)、左室后壁厚度(LVPWd)以及左心室射血分数(M-EF);留取左室短轴基底段、中间段及心尖段二维灰阶动态图像,采用Qlab软件分析左室短轴16节段(心尖除外)收缩期峰值轴向应变及应变率;采集左心室实时三维全容积图像,测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、射血分数(EF3d),分析左心室16节段(心尖除外)达收缩期最小容积点时间的标准差(Tmsv 16-SD、Tmsv 12-SD、Tmsv 6-SD)及最大时间差(Tmsv 16-Dif、Tmsv 12-Dif、Tmsv 6-Dif),并对标准差及时间差进行心率校正。结果:UM组LVESV、LVEDd、IVSd及LVPWd均明显大于对照组(P<0.05),EF3d明显小于对照组(P<0.05),左室短轴3个切面的应变及应变率均比对照组明显降低(P<0.01);UM患者16节段、12节段(中间段和基底段)和6节段(基底段)Tmsv的标准差和最大时间差值均明显大于对照组(P<0.01)。结论:2DSTI和RT-3DE能更加准确无创地判断UM患者的左心收缩功能及同步性。

Objective：Using two-dimensional speckle tracking imaging（2DSTI）and real-time three-di-mensional echocardiography（RT-3DE）to evaluate the left ventricular systolic function and synchrony in pa-tients with uremic myocardiopathy（UM）.Methods：Thirty-three cases of UM patients and 35 normal sub-jects were enrolled in this study.The left ventricular end-diastolic internal diameter（LVEDd ）,left ventric-ular end-systolic internal diameter （LVESd）,interventr icular septum diameter（IVSd）,left ventricular posterior wall diameter（LVPWd）and M-mode ejection fraction （M-EF）were obtained on M-Teichholz method.The two-dimensional dynamic gray-scale images of left ventricular shoRT-axis views of the basal, middle and apical plane were acquired.Peak systolic circumferential strain（C.Strain）and Peak systolic circumferential strain rate（C.Strain .Rate）of 16 segments （except apex cordis）were analysed by Qlab software.RT-3DE was wsed to obtain the left ventricular full-volume images and used Qlab 9.0 software to analyze datas,such as the end diastolic volume（LVEDV）,end systolic volume（LVESV）and ejection fraction（EF3d ）of left ventricule,in addition the time to minimal systolic volume （Tmsv）of 16,12,6-seg-mental standard deviation（Tmsv 16,12,6-SD）was calculated.The maximal difference of correspongding＆nbsp;segments（Tmsv 16,12,6-Dif）were also derived from Qlab software,The above parameters as a percentage of the cardiac cycle with different heart rates between patients were also calculated from the Qlab software, which were Tmsv 16,12,6-SD /R-R（%）and Tmsv 16,12,6-Dif/R-R（%）,rspectively.Results：The in-dices of LVEDd,IVSd,LVPWd and LVESV were significantly higher while EF3d were significantly lower in the UMgroup than those of control group（P 〈0.05）;both C.Strain and C.Strain.rates of UM group were significantly lower than those of control group（P 〈0.01）.As to Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD, Tmsv 16-Dif,Tmsv 12-Dif and Tmsv 6-Dif,all parameters in UM group were higher than those of control group （P 〈0.01）.Conclusion：2DSTI and RT-3DE can be used to evaluate the left ventricular systolic func-tion and synchrony in patients with uremic myocardiopathy more accurately and noninvasively.