超声二维斑点追踪成像技术评估慢性心力衰竭患者左心室内心肌收缩不同步性

Evaluation of left ventricular mechanical dyssynchrony in chronic heart failure patients by two-dimensional speckle tracking imaging

目的探讨超声二维斑点追踪技术(2D-STI)评价慢性心力衰竭(CHF)患者左心室内心肌收缩不同步性的临床应用价值。方法采集80例CHF患者及20例正常成人左心室短轴切面的动态二维图像及心尖四腔切面的动态三维全容积图像。依据NYHA分级法将病例组分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组。应用2D-STI技术分析左心室16节段的时间-应变曲线,测量左心室不同步参数,即Tcsbfirst-SD、Tcsmfirst-SD、Tcsafirst-SD、Trsbfirst-SD、Trsmfirst-SD、Trsafirst-SD。应用三维超声心动图技术测量左心室射血分数(LVEF)。采集受试者经胸心电图及血浆NT-pro BNP值。结果病例组Ⅱ组、Ⅲ组、Ⅳ组患者的Tcsbfirst-SD、Tcsmfirst-SD、Tcsafirst-SD均高于对照组(P<0.05),Ⅰ组患者与对照组的差别无统计学意义(P>0.05)。病例组各组患者的Trsmfirst-SD、Trsafirst-SD均高于对照组(P<0.05)。病例组Ⅲ组、Ⅳ组患者的Trsbfirst-SD高于对照组(P<0.05),Ⅰ组、Ⅱ组患者与对照组的差别无统计学意义(P>0.05)。以上不同步参数均与左心室射血分数有显著的负相关性(均P<0.001);均与NT-pro BNP有显著的正相关性(均P<0.001)。结论利用2D-STI技术检测的Tfirst-SD不同步参数可用来评价不同级别CHF患者左心室内心肌收缩的不同步性。

Objective To evaluate left ventricular mechanical dyssynchrony in chronic heart failure(CHF) patients using two-dimensional speckle tracking imaging(2D-STI). Methods A total of 80 patients with CHF and 20 healthy individuals were enrolled. All patients were classified into Ⅰ, Ⅱ, Ⅲand Ⅳ four groups by NYHA functional class. The images were recorded in the left ventricular short-axis plane by two-dimensional echocardiography and in the apical 4-chamber by three-dimensional echocardiography. All participants underwent ECG and the NT-pro BNP tests. Meanwhile, time-radial strain(rs) and time-circumferential strain(cs) curves were recorded from the 16 segments of the left ventricular short-axis plane by 2D-STI. The left ventricular mechanical dyssynchrony parameters(Tcsbfirst-SD, Tcsmfirst-SD, Tcsafirst-SD, Trsbfirst-SD, Trsmfirst-SD, Trsafirst-SD) were obtained. The left ventricular ejection fraction(LVEF) were measured by three-dimensional echocardiography. Results Tcsbfirst-SD, Tcsmfirst-SD, Tcsafirst-SD of Ⅱ, Ⅲ, Ⅳ groups increased significantly than that in normal groups(P<0.05). But there were no statistically significant differences between the Ⅰ groups and the normal groups(P>0.05). Trsmfirst-SD, Trsafirst-SD of all cases increased significantly than that in normal groups(P<0.05). Trsbfirst-SD of Ⅲ, Ⅳ groups increased significantly than that in normal groups(P<0.05), but there were no statistically significant differences between the Ⅰ, Ⅱ groups and normal groups(P>0.05). There was remarkable negative correlation between all of the mechanical dyssynchrony parameters and the LVEF(all P<0.001), but the positive correlation with the NT-pro BNP(all P<0.001). Conclusion Tfirst-SD measured by 2D-STI can assess the changes of left ventricular mechanical dyssynchrony in patients with different degrees of CHF.