峰值应变离散度评价心脏再同步治疗后左室同步性及心功能变化

Evaluation of the left ventricular synchronism and cardiac function after cardiac resynchronization therapy with peak strain discrete

目的:本研究旨在探讨应用二维斑点追踪成像(2D-STI)评价慢性心力衰竭(CHF)患者心脏再同步治疗(CRT)术后左室同步性及心功能的变化。方法:入选2019年1月—2019年12月符合CTR适应证的CHF患者共20例,运用2D-STI测量患者术前、术后左心室相应17个节段收缩期纵向峰值应变(LS)及纵向峰值应变达峰时间(TTPLS),并绘制纵向峰值应变-时间曲线,以评价心功能变化;同时,计算各节段TTPLS的标准差(PSD)、左心室纵向应变达峰时间极差值(TTPLSR)及左心室不同步节段个数(LVDSN),以评价左室同步性变化。结果:与术前比较,患者术后心尖两腔心、心尖四腔心、左室长轴切面及左室整体LS均明显升高[分别为(-3.5±2.9)%∶(-5.5±3.0)%,(-2.3±2.2)%∶(-5.2±4.1)%,(-3.4±2.6)%∶(-5.7±2.7)%,(-3.0±1.7)%∶(-5.6±3.0)%,均P<0.05]。PSD、TTPLSR、LVDSN在术后均有明显改善[(176.2±26.2)ms∶(90.0±46.2)ms,(530.5±102.6)ms∶(222.8±69.0)ms,(13.3±2.1)个∶(7.0±2.6)个,均P<0.05]。PSD、TTPLSR均与LVEF呈负相关(r=-0.855,r=-0.746,均P<0.05)。结论:2D-STI可直观、准确评估CHF患者CRT术后心功能和左室同步性;PSD有望成为评价CRT患者左室同步性变化的新参数。

Objective:To evaluate the changes of left ventricular synchronism and cardiac function after cardiac resynchronization therapy(CRT)in patients with chronic heart failure(CHF)by two-dimensional speckle tracking imaging(2D-STI).Methods:Twenty CHF patients who fulfilled the indications of CRT from January to December,2019 were enrolled in the study.Longitudinal peak strain(LS)and longitudinal peak strain peak time(TTPLS)of the corresponding 17segments of the left ventricle were measured by 2D-STI preoperatively and postoperatively.Longitudinal peak strain-time curves were drawn to evaluate the changes of cardiac function.The standard deviation of TTPLS(PSD)for each segment,left ventricular time to peak longitudinal strain range(TTPLSR)and left ventricular dyssynchrony segments number(LVDSN)were calculated to evaluate left ventricular synchronism.Results:Compared with the preoperative parameters,the LS in two-chamber and four-chamber heart of the apex,the left ventricular long axis sections and global longitudinal peak strain(GLS)were significantly increased(-3.5±2.9%vs-5.5±3.0%,-2.3±2.2%vs-5.2±4.1%,-3.4±2.6%vs-5.7±2.7%,-3.0±1.7%vs-5.6±3.0%,P<0.05).PSD,TTPLSR and LVDSN improved significantly(176.2±26.2ms vs 90.0±46.2ms,530.5±102.6ms vs 222.8±69.0ms,13.3±2.1vs 7.0±2.6ms,all P<0.05).Both PSD and TTPLSR were negatively correlated with LVEF(r=-0.855,r=-0.746,all P<0.05).Conclusion:2DSTI can evaluate cardiac function and left ventricular synchronism of CHF patients after CRT therapy directly and accurately.PSD is a new parameter to evaluate the changes of left ventricular synchronism in patients with CRT.