三维斑点追踪显像预测心脏再同步化治疗效果的价值

The prediction of response to cardiac resynchronization therapy by real-time three-dimensional speckle tracking echocardiography

目的应用三维斑点追踪显像（3DSTI）和二维斑点追踪显像（2D-STI）评价慢性心力衰竭患者心脏再同步化治疗（CRT）前和治疗后6个月左心室收缩功能与机械同步性，探讨并比较两种方法预测CRT疗效的价值。方法因慢性心力衰竭拟行CRT治疗的患者41例，应用3D-STI测量左室三维纵向应变（LS-3D）及三维纵向应变达峰时间标准差（Tls-16SI〉3D）；应用2D-STI测量左室二维纵向应变（LS-2D）及二维纵向应变达峰时间标准差（Tlls-16SD-12D）；评价并对比两种方法预测CRT疗效的价值。随机选取10例CRT患者及10例健康志愿者，评价并对比两种方法评价心肌应变及心肌收缩同步性的重复性。结果术后6个月，CRT有效组各超声指标均显著改善（P〈0．（）5），而CRT无效组仅LVEF及LS-3D显著改善（P〈0．05）。LS-3D、Tls-16SD-3D以及LS-2D对CRT的疗效均有一定的预测价值（ROC曲线下面积分别为：LS-3D 0．816，Tls-16SD3D0．845，l。S-2D0．661，均P〈0．05）。3D-STI各测量指标的重复性均优于2D-STI，而LS-2D的观察者间重复性不理想。结论3D-STI能够准确评价CRT前后心肌收缩力及收缩同步性的变化，并能预测CRT疗效，3D-STI在预测价值、重复性方面较2D-STI更具优势。

Objective To evaluate left ventricular（LV） contractility and mechanical synchronization in chronic heart failure patients undergoing cardiac resynchronization therapy （CRT） before and 6 months after operation by three-dimensional speckle tracking imaging （3D-STI） and two dimensional speckle tracking imaging（2D-STI）, and to compare the value of the two methods in prediction of CRT response. Methods Forty-one patients with chronic heart failure underwent CRT were involved. Three-dimensional and two dimensional longitudinal strain （LS-3D, LS-2D） and their standard deviations of the time to peak longitudinal strain （Tls 16SD-3D, TIs-16SD-2D） were analyzed before and after CRT. Ten CRT patients and 10 healthy controls were chosen to evaluate the reproducibility of 2D and 313 STI parameters. Results At 6-month follow-up after CRT, echocardiography indices in the response group were significantly improved （all P 〈0. 05） while only LVEF and LS-3D were improved in nonresponse group. The area under the ROC curve for LS 3D,Tls 16SD-3D and LS-2D were 0.816,0.845 and 0.661 respectively（ P〈0.05）. The reproducibility of 3D-STI indices was superior to that of 2D-STI, especially in CRT patients. Conclusions Both 2D-STI and 3D-STI can evaluate LV myocardial contractility and the mechanical dyssynchronization, however, 3D-STI is superior in prediction value and reproducibility compared with 2D-STI.