三平面组织同步成像定量评价冠心病患者左心室节段非同步运动

摘要

Purpose To quantitatively assess left ventricular segmental motion dyssynchronicity in patients with coronary artery disease and to analyze the relationship with left ventricular function using triplane tissue synchronization imaging. Materials and Methods 34 patients with coronary artery disease (CAD) and abnormal wall motion as well as 35 normal subjects were examined. The tissue velocity imaging was obtained on apical four-champer view performed by triplane tissue synchronization imaging echocardiography. Time to peak systole (Tp) and velocities to peak systole (Vp) were measured in 12 segments of 6 left ventricular walls. Standard deviation of Tp, Vp and the maximal difference in Tp, Vp between any two segments were calculated (Tp-SD, Vp-SD, Tp-maxD, Vp-maxD). Left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) were calculated using Simpson's biplane method. Results The LVEDV and LVESV of CAD group were larger than those of control group, and LVEF was decreased than that of control group(P<0.001). The Tp, Tp-SD, Tp-maxD of CAD group were longer than those in control subjects. The Vp, Vp-SD, Vp-maxD of CAD group were significantly decreased (all P < 0.001). The correlations were statistically significant between Tp, Vp and LVEF in two groups (Tp correlated with LVEF; r= -0.559, P< 0.001; Vp correlated with LVEF: r = 0.801, P < 0.001). Conclusion Triplane tissue synchronization imaging echocardiography can be used to evaluate left ventricular systolic dyssynchonicity in patients with CAD. Tp, Tp-SD, Tp-maxD, Vp, Vp-SD, Vp-maxD are potential parameters for assessing left ventricular systolic synchronicity. Abnormal synchronism may aggravate LV systolic dysfunction.%目的 探讨三平面组织同步成像技术定量评价冠心病患者左心室节段收缩非同步性运动及其与左心室收缩功能的关系.资料与方法 34例冠心病患者和35例正常对照者,应用三平面组织同步成像技术获得心尖四腔切面组织速度图,获取左心室6个壁共12个节段的收缩期达峰时间(Tp)、达峰速度(Vp),并计算Tp、Vp的标准差(Tp-SD、Vp-SD)及12个节段中任意2个节段Tp、Vp的最大差值( Tp-maxD、Vp-maxD).同时采用Simpson双平面法测量左室射血分数(LVEF)、左室舒张末期容积(LVESV)、左室收缩末期容积(LVEDV).结果 冠心病组LVEDV、LVESV较正常对照组增加,LVEF较正常对照组减小,差异均有统计学意义(P＜ 0.001).与正常对照组相比,冠心病组Tp、Tp-SD、Tp-maxD均明显延迟,Vp、Vp-SD、Vp-maxD均明显降低(P＜0.001);Tp与LVEF呈负相关(r=-0.559,P＜0.001);Vp与LVEF呈正相关(r=0.801,P＜ 0.001).结论 三平面组织同步成像可用于定量评价冠心病患者左心室非同步运动,Tp、Tp-SD、Tp-maxD、Vp、Vp-SD、Vp-maxD 可作为定量评价左室收缩运动同步性的有效指标,且左室运动同步性异常加重左室收缩功能异常.