全容积三维超声对冠心病患者左心局部结构及收缩功能的评估价值

摘要

目的：探讨全容积三维超声心动图（FV-3DE）对冠心病患者左心室局部结构和收缩功能的评估价值。方法选取25例符合临床支架介入标准的冠心病患者和20例正常对照者，均行FV-3DE检查，采用自带QLAB软件对三维超声图像进行处理，得到左室整体及17节段容量-时间曲线，获取左心室17节段局部舒张末期容量（REDV）、局部收缩末期容量（RESV）、局部心搏量（RSV）和局部射血分数（REF），采用SPSS 13.0统计学软件对组间测值进行对比分析。结果①冠心病组与正常对照组相比，左室17节段容量-时间曲线运动分散、不规则，彼此交错，各节段曲线不同步，缺血梗死节段容积曲线波动幅度小，非缺血区相应节段局部容量增大，表示其收缩代偿功能增强。正常对照组曲线均呈“U”字抛物线形，排列规则有序，各节段曲线步调一致，该17节段室壁容积从心底至心尖各节段容积测值呈递减趋势。②冠心病组左心室17节段中大部分REDV和RESV数值明显大于正常对照组，REF明显小于正常对照组（P<0.05），以运动异常的节段前间壁、前壁、后壁及心尖段下壁显著（P<0.05或P<0.01）；术后较术前REDV、RESV有所减低，REF数值均不同程度增高至正常，以前间壁、前壁、后壁及心尖段下壁显著（P<0.05）。结论 FV-3DE技术能定量评价正常心脏及冠心病缺血重构心脏局部容积和心功能，在临床中能提供丰富准确的信息，是一项新方法。%Objective To explore the evaluation value of full-volume three dimensional echocardiography (FV-3DE) in left ventricular regional conifguration and systolic function for patients with coronary heart diseases.Methods Altogether 25 cases with coronary heart diseases who were suitable for PCI (Percutaneous Coronary Intervention) and 20 healthy people underwent FV-3DE examinations. QLAB Software was applied to process the three dimensional images so as to obtain complete left ventricle and 17 segment volume-time curve, regional end diastolic volume (REDV), regional end systolic volume (RESV), regional stroke volume (RSV) and regional ejection fraction (REF). The SPSS 13.0 statistics software was applied to compare the categorical variables between two groups.Results (1) Compared with Normal Group, the regional volume-time curve of 17 segments in the left ventricle in Coronary Heart Disease Group was overlap and disorder. Small lfuctuation of the ischemic region volume curve was seen. Normal region myocardium local volume was enlarged, which indicated that compensatory constriction was larger. The regional volume-time curve of 17 segments in the left ventricle in Normal Group displayed U shape with orderly arrangements. The volume was decreased form the base of heart to apex of heart. (2) Most of the REDV and RESV of 17 segments in the left ventricle in Coronary Heart Disease Group were more larger than Normal Group; while most of REF in Coronary Heart Disease Group was lower than Normal Group (P<0.05), especially in the anteroseptal, anterior, posterior and apical inferior segments (P<0.05 orP<0.01). Post-PCI RE DV and RESV were reduced compared to pre-PCI patients; while REF was increased to normality, especially in the anteroseptal, anterior, posterior and inferior segments (P<0.05).Conclusion FV-3DE provided a new potential method in assessing left ventricular regional volume and heart functions, which could offer rich and accurate clinical information.