目的：应用实时三维超声心动图（RT-3DE）和二维斑点追踪（2D-STI）探讨冠心病（CHD）患者左心室心肌节段力学与局部容积负荷间关系在评价左心室收缩不同步方面的临床应用价值，及其与LVEF的相关性。方法：24例心肌缺血患者（心肌缺血组）、26例心肌梗死患者（心肌梗死组）和30例正常对照者（正常组）分别行2D-STI和RT-3DE检查，应用Qlab 8.1软件脱机分析，获得左心室心肌节段力学时间指标（Tls-16%、Trs-12%、Tcs-12%、Trot-12%）及其标准差（Tls-16-SD%、Trs-12-SD%、Tcs-12-SD%、Trot-12-SD%）、左心室心肌局部容积负荷时间指标（Tmsv-16%）及其标准差（Tmsv-16-SD%）、心肌节段力学与局部容积负荷间的时间差（Tlsv%、Trsv%、Tcsv%、Trotv%）。结果：①与正常组比较，心肌缺血组Tls-16%、Tls-16-SD%、Tmsv-16%、Tmsv-16-SD%、Tlsv%有明显差异（P<0.05）。②与正常组和心肌缺血组比较，心肌梗死组上述时间指标均有明显差异（P<0.05，P<0.01）。③心肌梗死组Tlsv%、Trsv%、Tcsv%、Trotv%均与LVEF呈负相关。结论：Tlsv%、Trsv%、Tcsv%、Trotv%可作为评价心肌梗死患者左心室收缩不同步的新参数，Tlsv%可能是预测心肌缺血患者左心室收缩不同步的敏感指标。
Abstract
Objective: To explore the relationship of myocardial segmental mechanics and regional volume change with left ventricular systolic asynchrony in patients with coronary heart disease(CHD) by real-time three-dimensional echocardiography(RT-3DE) and two-dimensional speckle imaging(2D-STI). Methods: Twenty-four patients with myocardial ischemia(myocardial ischemia group), 26 patients with myocardial infarction(myocardial infarction group) and 30 normal subjects(control group) were enrolled in this study. All patients were measured with 2D-STI and RT-3DE. Images were acquired and analyzed off-line on Qlab 8.1 station. The left ventricular myocardial segmental mechanics time indexes and standard deviation(Tls-16%, Trs-12%, Tcs-12%, Trot-12%, and Tls-16-SD%, Trs-12-SD%, Tcs-12-SD%, Trot-12-SD%), the left ventricular regional volume change time index and standard deviation(Tmsv-16% and Tmsv-16-SD%) were obtained, respectively. The difference between myocardial segmental mechanics and regional volume change(Tlsv%, Trsv%, Tcsv%, Trotv%) were calculated. Results: Compared with control group, Tls-16%, Tls-16-SD%, Tmsv-16%, Tmsv-16-SD% and Tlsv% were significantly prolonged(P<0.05) in myocardial ischemia group. Compared with myocardial ischemia group and control group, all the above time indexes had significant differences(P<0.05, P<0.01) in myocardial infarction group. Tlsv%, Trsv%, Tcsv% and Trotv% were significantly negatively correlated with LVEF, respectively in myocardial infarction group. Conclusion: Tlsv%, Trsv%, Tcsv% and Trotv% can become new indicators to assess the left ventricular asynchrony in myocardial infarction patients. Tlsv% is a potential sensitive indicator to evaluate the left ventricular asynchrony in myocardial ischemia patients.
关键词
冠状动脉疾病；心室功能 /
左；超声心动描记术
Key words
Coronary disease /
Ventricular function, left /
Echocardiography
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Wu J, Mukerji R, Xie GY. Relationship of myocardial mechanics and regional volume change in patients with left ventricular systolic dysfunction[J]. Int J Cardiovasc Imaging, 2011, 27(6): 825-831.
[2]Chung ES, Leon AR, Tavazzi L, et al. Results of the predictors of response to CRT(PROSPECT) trial[J]. Circulation, 2008, 117(20): 2608-2616.
[3]Takeuchi M, Jacobs A, Sugeng L, et al. Assessment of left ventricular dyssynchrony with real-time-3-dimensional echocardiography: comparison with Doppler tissue imaging[J]. J Am Soc Echocardiogr, 2007, 20(12): 1321-1329.
[4]Chan J, Hanekom L, Wong C, et al. Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function[J]. J Am Coll Cardiol, 2006, 48(10): 2026-2033.
[5]郑洁怀，杨怀安，王刚. 斑点追踪技术对急性梗死心内外膜扭转运动的研究[J]. 心脑血管病防治，2013，13（4）：263-265.
[6]Delgado V, Ypenburg C, van Bommel RJ, et al. Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal circumferential, and radial strain in cardiac resynchronizaion therapy[J]. J Am Coll Cardiol, 2008, 51(20): 1944-1952.
[7]张丽，谢明星，王新房，等. 超声二维斑点追踪显像技术评价不同年龄正常成人左心室扭转运动的初步研究[J]. 中华超声影像学杂志，2007，16（9）：746-750.
[8]Burgess MI, Jenkins C, Chan J, et al. Measurement of left ventricular dyssynchrony in patients with ischemic cardiomyopathy: a comparsion of real-time three-dimensional and tissue Doppler echocardiography[J]. Heart, 2007, 93(10): 1191-1196.
