2DSTI联合RT-3DE评价尿毒症性心肌病患者左心室收缩功能及同步性的应用价值

Evaluation of left ventricular systolic function and synchrony in patients with uremic myocardiopathy using 2DSTI and RT-3DE

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)评价尿毒症性心肌病(uremic myocardiopathy,UM)患者左心室收缩功能与同步性。方法:对33例尿毒症患者及35例健康体检者行常规超声心动图检查,采用M型取样线获得左室舒张末期内径(LVEDd)、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(LVEF);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(C.Strain)及应变率(C.Strain.Rate);再采用实时三维超声心动图获取左心室全容积图像,采集左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数,并采用Qlab软件分析左心室16节段(心尖除外)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均大于正常组(P<0.05),LVEF小于正常组(P<0.05);UM组左室短轴3个切面的应变及应变率均比正常组降低,差异具有统计学意义(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大于正常组(P<0.01)。结论:2DSTI联合RT-3DE能更加准确且无创地判断UM患者的左心室收缩功能及同步性。

Objective：To evalute the left ventricular systolic function and synchrony in patients with uremic myocardiopathy（UM）using two-dimensional speckle tracking imaging（2DSTI）and real-time three-dimensional echocardiography（RT-3DE）.Methods：Thirtythree cases of UM patients and thirty-five normal subjects were enrolled in this study.The left ventricular end-diastolic internal diameter（LVEDd）,left ventricular end-systolic internal diameter（LVESd）,interventricular septum diameter（IVSd）,left ventricular posterior wall diameter（LVPWd）and left ventricular ejection fraction（LVEF）were obtained on MTeichholz 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 16segments（except apex cordis）were analyzed by Qlab software.We also used RT-3DE to obtain the left ventricular full-volume images and used Qlab 9.0software to analyze datas,such as the end diastolic volume（LVEDV）,end systolic volume（LVESV）and LVEF.The time to minimal systolic volume（Tmsv）of 16,12,6-segmental standard deviation（Tmsv 16,12,6-SD）,the maximal difference of correspongding 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 indices of LVEDd,IVSd,LVPWd and LVESV were significantly higher,while LVEF in the UM group was significantly lower than those of NC group（P0.05）.Both C.Strain and C.Strain.Rate of UM group are significantly lower than NC group（P0.01）.As to Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif and Tmsv 6-Dif,UM Group is higher than NC group（P 0.01）.Conclusion：2DSTI and RT-3DE can evalute the left ventricular systolic function and synchrony in patients with uremic myocardiopathy more accurately and noninvasively.