三维超声左心室造影结合核素评价心力衰竭患者左心室收缩功能与同步性

3Dechocardiography combined with SPECT in assessing left ventricular systolic function of HF patients and its synchronism

目的应用三维超声左心室造影(C3DE)结合门控核素心肌灌注显像(GSMPI)相位分析评价慢性心力衰竭患者左心室收缩功能与同步性。方法选择老年慢性心力衰竭患者31例,根据LVEF分为轻-中度组18例(LVEF 35%~50%)和重度组13例(LVEF<35%),另选同期健康体检者15例为对照组。入选者1周内行C3DE和GSMPI。C3DE参数包括左心室16、12节段达最低收缩末容积时间标准差(Tmsv-16SD、Tmsv-12SD),左心室16、12节段收缩非同步指数(16R-SDI、12R-SDI)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)及LVEF;GSMPI参数包括相位直方图带宽(phase histogram bandwidth,PHB)、相位标准差(phase stress scores,PSD)及LVEF。分析各组左心室收缩功能与同步性的差异。结果与对照组比较,轻-中度组和重度组Tmsv-16SD[(66.0±35.7)ms和(137.1±48.5)ms vs(49.0±37.9)ms]、Tmsv-12SD[(45.6±32.7)ms和(126.5±48.6)ms vs(40.1±41.4)ms],16R-SDI[(8.5±4.0)%和(15.1±4.3)%vs(5.8±4.4)%]、12R-SDI[(5.8±3.6)%和(15.1±5.3)%vs(5.1±5.8)%],PHB(36.8±11.5和69.6±25.5 vs 27.6±9.8)和PSD(8.9±5.5和16.1±6.0 vs 6.4±4.2)明显延长,且重度组较轻-中度组延长更明显(P<0.05);LVEDV、LVESV明显增大,LVEF明显减低;重度组左心室收缩失同步发生率明显高于轻-中度组,差异有统计学意义(76.9%vs 27.7%,P<0.05);Tmsv-16SD、16R-SDI、PHB和PSD均与LVEF呈负相关(r=-0.74、r=-0.74,r=-0.69、r=-0.62,P<0.01)。结论C3DE能较准确评价左心室收缩功能与同步性,心力衰竭患者存在不同程度的左心室收缩不同步,且与LVEF相关。

Objective To assess the left ventricular systolic function of HF patients by 3D echocardiography combined with gated SPECT myocardial perfusion imaging(GSMPI)and its synchronism.Methods Thirty-one HF patients were divided into mild-moderate HF group(n=18)with their LVEF=35%-50%and severe HF group(n=13)with their LVEF<35%with 15 healthy persons undergoing physical examination served as a control group.They underwent 3D echocardiography and GSMPI within 1 week after admission.The 3D echocardiography parameters included the standard deviation of minimum end-systolic volume time(Tmsv-16SD,Tmsv-12SD)and systolic asynchrony index(16R-SDI,12R-SDI)of left ventricle segments 16 and 12,the GSMPI parameters included phase histogram bandwidth(PHB),phase stress deviation(PSD)score and LVEF.The left ventricular systolic function and its synchronism in 3 groups were analyzed.Results The Tmsv-16SD,Tmsv-12SD,16R-SDI,12R-SDI,PHB and PSD were significantly prolonged in mild-moderate HF group and severe HF group than in control group,and was significantly longer in severe HF group than in mild-moderate HF group(Tmsv-16SD:137.1±48.5 ms vs 66.0±35.7 ms,Tmsv-12SD:126.5±48.6 ms vs 45.6±32.7 ms,16R-SDI:15.1±4.3%vs 8.5±4.0%,12R-SDI:15.1±5.3%vs 5.8±3.6%,PHB:69.6±25.5 vs 36.8±11.5,PSD:16.1±6.0 vs 8.9±5.5,P<0.05).The LVEDE and LVESV were significantly increased while the LVEF was significantly decreased.The incidence of left ventricular systolic asynchronism was significantly higher in servere HF group than in mild-moderate HF group(76.9%vs 27.7%,P<0.05).The Tmsv-16SD,16R-SDI,PHB and PSD were negatively related with the LVEF(r=-0.74,r=-0.74,r=-0.69,r=-0.62,P<0.001).Conclusion 3D echocardiography can accurately assess the left ventricular systolic function and its synchronism.The left ventricular systolic asynchronism is related with the LVEF in HF patients.