三维斑点追踪显像预测心脏再同步化治疗效果的价值

摘要

Objective To evaluate left ventricular(LV)contractility and mechanical synchronization in chronic heart failure patients undergoing cardiac resynchronization therapy(CRT)before and 6 months after operation by three-dimensional speckle tracking imaging(3D-STI)and two dimensional speckle tracking imaging(2D-STI),and to compare the value of the two methods in prediction of CRT response. Methods Forty-one patients with chronic heart failure underwent CRT were involved.Three-dimensional and two-dimensional longitudinal strain(LS-3D,LS-2D)and their standard deviations of the time to peak longitudinal strain(Tls-16SD-3D,Tls-16SD-2D)were analyzed before and after CRT.Ten CRT patients and 10 healthy controls were chosen to evaluate the reproducibility of 2D and 3D STI parameters.Results At 6-month follow-up after CRT,echocardiography indices in the response group were significantly improved(all P <0.05)while only LVEF and LS-3D were improved in nonresponse group.The area under the ROC curve for LS-3D,Tls-16SD-3D and LS-2D were 0.816,0.845 and 0.661 respectively(P <0.05). The reproducibility of 3D-STI indices was superior to that of 2D-STI,especially in CRT patients. Conclusions Both 2D-STI and 3D-STI can evaluate LV myocardial contractility and the mechanical dyssynchronization,however,3D-STI is superior in prediction value and reproducibility compared with 2D-STI.%目的 应用三维斑点追踪显像 (3D-STI)和二维斑点追踪显像 (2D-STI)评价慢性心力衰竭患者心脏再同步化治疗 (CRT)前和治疗后6个月左心室收缩功能与机械同步性,探讨并比较两种方法预测CRT疗效的价值.方法 因慢性心力衰竭拟行CRT治疗的患者41例,应用3D-STI测量左室三维纵向应变 (LS-3D)及三维纵向应变达峰时间标准差 (Tls-16SD-3D);应用2D-STI测量左室二维纵向应变 (LS-2D)及二维纵向应变达峰时间标准差 (Tls-16SD-2D);评价并对比两种方法预测 CRT疗效的价值.随机选取10例CRT患者及10例健康志愿者,评价并对比两种方法评价心肌应变及心肌收缩同步性的重复性.结果 术后6个月,CRT 有效组各超声指标均显著改善 (P <0.05),而 CRT 无效组仅 LVEF及 LS-3D显著改善(P <0.05).LS-3D、Tls-16SD-3D 以及 LS-2D 对 CRT 的疗效均有一定的预测价值 (ROC 曲线下面积分别为:LS-3D 0.816,Tls-16SD-3D 0.845,LS-2D 0.661,均 P <0.05).3D-STI各测量指标的重复性均优于2D-STI,而LS-2D的观察者间重复性不理想.结论 3D-STI能够准确评价CRT前后心肌收缩力及收缩同步性的变化,并能预测CRT疗效,3D-STI在预测价值、重复性方面较2D-STI更具优势.