实时三维超声左心室造影评价慢性心力衰竭患者的左心室收缩同步性

Real-time Three-dimensional Contrast-enchanced Echocardiography in Evaluating Left Ventricular Systolic Synchrony of Patients with Chronic Heart Failure

目的探讨三维超声左心室造影(3D-CE)测定慢性心力衰竭患者左心室收缩同步性的价值。资料与方法纳入慢性心力衰竭患者32例,包括轻中度心力衰竭组(n=20)和重度心力衰竭组(n=12),健康对照20例(对照组),1周内所有受检者行实时三维超声心动图(RT3DE)、3D-CE和门控SPECT心肌灌注显像(GSMPI)测定。利用Qlab定量分析软件测得左心室收缩同步性参数:左心室16、12节段达收缩末最小容积的时间标准差(Tmsv16-SD、Tmsv12-SD)及经心率校正后值即非同步指数(16R-SDI、12R-SDI);GSMPI应用4DM软件获得左心室收缩同步性参数:相位直方图带宽(BW)、相位标准差(SD),比较3组的左心室收缩同步性差异。以对照组BW、16R-SDI最大值为界值,超过此界值诊断为左心室收缩不同步,统计3D-CE和GSMPI诊断左心室收缩不同步的情况,并对两种方法进行一致性检验。结果RT3DE显示,重度心力衰竭组Tmsv16-SD、16R-SDI低于对照组,差异有统计学意义(P<0.05);3D-CE显示,重度心力衰竭组Tmsv16-SD、Tmsv12-SD、16R-SDI、12R-SDI均低于对照组和轻中度心力衰竭组,差异有统计学意义(P<0.05)。GSMPI诊断为左心室收缩不同步者中2例3D-CE诊断为左心室收缩同步,GSMPI诊断为左心室收缩同步者中5例3D-CE诊断为左心室收缩不同步,两种检查方法的一致性较好(Kappa=0.690)。结论3D-CE可以准确评价左心室收缩同步性,与GSMPI有较好的一致性。

Purpose To explore the value of contrast enhanced real-time three-dimensional echocardiography(3D-CE)in measuring left ventricular systolic synchrony in patients with chronic heart failure.Materials and Methods Thirty-two patients with chronic heart failure were selected and divided into mild to moderate heart failure group(n=20)and severe heart failure group(n=12).20 healthy patients were chosen as controls(control group).Within one week,all patients received real-time three-dimensional echocardiography(RT3DE),3D-CE and gated SPECT myocardial perfusion imaging(GSMPI)measurement.Qlab quantitative analysis software was taken to measure parameters of left ventricular systolic synchronicity,namely 16 and 12 segmental left ventricular contraction at the end of the time standard deviation of the minimum volume(Tmsv16-SD,Tmsv12-SD)and value after heart rate correction namely asynchronous index(16R-SDI,12R-SDI).GSMPI application 4DM software was used to obtain parameters of left ventricular systolic synchronicity:phase histogram bandwidth(BW)and phase standard deviation(SD).Difference of left ventricular systolic synchronicity among three groups were compared.Taking maximum values of BW and 16R-SDI in control group as the boundary values,those beyond boundary values were diagnosed as left ventricular systolic dyssynchrony and cases of left ventricular systolic dyssynchrony diagnosed by 3D-CE and GSMPI were analyzed.Consistency testing was performed.Results RT3DE indicated that Tmsv16-SD and 16R-SDI in severe heart failure group were lower than that in the control group and the difference was of statistical significance(P<0.05).3D-CE showed that Tmsv16-SD,Tmsv12-SD,16R-SDI and 12R-SDI in severe heart failure group were all statistically lower than thaose in control group and mild to moderate heart failure group(P<0.05).There were 2 left ventricular systolic synchronicity diagnosed by 3D-CE among left ventricular systolic dyssynchrony diagnosed by GSMPI and 5 left ventricular systolic dyssynchrony diagnosed by 3D-CE among left ventricular systolic synchronicity diagnosed by GSMPI.Two examination methods showed well consistency(Kappa=0.690).Conclusion 3D-CE could be used to assess left ventricular systolic synchronicity accurately,which is of good consistency with GSMPI.