实时三平面组织同步显像技术在心脏再同步化治疗中的应用价值

摘要

目的：探讨实时三平面组织同步显像((RT3PE-TSI)技术在心脏再同步化治疗(CRT)中的临床应用价值。方法对24例拟行 CRT 的心力衰竭患者,在治疗前和 CRT 术后1个月优化治疗前及优化治疗后2个月分别行超声心动图检查,24例健康志愿者作为对照组。常规测量左室舒张末内径(LVIDd)、收缩末内径(LVIDs)、左室射血分数(LVEF)及左室流出道血流速度时间积分(VTILVOT )等。应用 RT3PE-TSI 技术测量左室壁基底段和中间段12个心肌节段的局部收缩达峰时间(Tp)、12节段收缩达峰时间的最大差值(12-Tp-DIF)和标准差(12-Tp-SD),确定室壁运动最延迟的心室壁节段,并依此指导起搏电极的放置位置；CRT 术后1个月在超声心动图指导下行起搏器 AV 和 VV 间期优化。结果在治疗前、治疗后、优化后和对照组,LVIDd、Tp、LVIDs、12-Tp-DIF 和12-Tp-SD 均依次降低,LVEF、VTILVOT 依次增高,组间差异均有统计学意义(P <0.05)。TSI 显示术前24例患者均存在左室内收缩不同步,最延迟收缩部位位于侧壁8例,下壁10例,后壁6例。左室起搏电极植入位置与收缩最延迟部位一致。相关性研究显示12-Tp-DIF 和12-Tp-SD 与 LVEF 具有良好的相关性(r 分别为-0.70,-0.73,P =0.000)。结论RT3PE-TSI 能够直观、准确地定量评价左室心肌运动的同步性,对 CRT 术前患者的筛选、指导左室电极的放置位置及起搏程序的优化等方面具有重要的临床指导意义和应用价值。%Objective To investigate the applicable value of tissue synchronization imaging (TSI)by real-time thriplane echocardiography (RT3PE)in cardiac resynchronization therapy (CRT).Methods Twenty-four patients with heart failure scheduled for CRT and 24 healthy controls were enrolled.Two dimensional echocardiography was performed to get the left ventricular internal diameter at end-diastole and end-systole(LVIDd,LVIDs ),left ventricular ejection fraction (LVEF ),velocity time integral of left ventricular outflow tract flow (VTILVOT ).The RT3PE TSI was performed to measure the time to peak systolic velocities(Tp)of left ventricle basal and middle segments(12 segments),software will automatically calculate the maximal difierence (12-Tp-DIF)and standard deviation (12-Tp-SD)of Tp in 12 segment. Identity the segment where wall motion most delay and to guide electrode placement.AV and VV interval optimization were performed under guidance of TSI after 1 month of CRT.Results In before CRT,after CRT,after optimization and control group,LVIDd,Tp,LVIDs,12-Tp-DIF and 12-Tp-SD were decreased in the order,LVEF and VTILVOT were increased in the order.There were significant difference between the groups(all P < 0.05 ).TSI showed that left ventricular systolic dyssynchrony was present in all patients before CRT.The most delay segment and electrode location was consistent.There were close correlation between 12-Tp-DIF and LVEF (r =-0.70,P =0.000),between 12-Tp-SD and LVEF(r =-0.73,P =0.000).Conclusions Left ventricular systolic synchronicity can be evaluated accurately and intuitively using TSI by RT3PE.It has important clinical significance in prospectively select patients for CRT,help to guide electrode placement and to optimize device programming.