二维斑点追踪成像评价再同步化治疗对慢性心力衰竭患者右心室功能的影响

摘要

Objective To evaluate the right ventricular function in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) by 2-dimensional speckle imaging (2D-STI).Methods 46 patients with CHF were divided into responders to CRT and non-responders to CRT according the standard of a decline in LV end-systolic volume ≥ 10％.All the patients received echocardiography examination 1-3 days before CRT and 6 month after CRT.Tissue Doppler imaging (TDI) indices included SD of time to peak velocity in systole (Ts-SD) among 12 segments.Right ventricular diameters included RV basal transverse diameter (D1),RV middle transverse diameter (D2) and RV longitudinal diameter (D3) in apical four views.2D-STI indices included systolic strain (S) and stain rate (SR) of basal or middle segment of RV free wall.Results Compared with before CRT,LVEDd,LVEDV,LVESV and Ts-SD significantly decreased,LVEF significantly increased in responders 6 months after CRT.Before CRT,compared with nonresponders,there was no significant difference of D1,D2 and D3 in responders,while S and SR in basal or middle segment of RV free wall were higher than non-responders.Compared with before CRT,D1,D2 and D3 in responders decreased significantly,S and SR in basal or middle segment of RV free wall increased significantly,while there was no difference in non-responders.There were significant negative correlation between S and SR in basal or middle segment of RV free wall and Ts-SD in responders.Conclusions The remodeling and systolic function of RV are improved after CRT.It may help for improving the efficacy of CRT when takes RV function data into account before CRT.%目的 应用二维斑点追踪(2D-STI)技术评价充血性心力衰竭(CHF)患者再同步化治疗(CRT)前后右室功能的变化,探讨CRT治疗对CHF患者右室功能的影响.方法 CHF组患者46例,根据CRT术后6个月左室收缩末容积降低≥10％的标准将CRT患者分为CRT有反应组(26例)和CRT无反应组(16例).所有患者均于CRT术前1～3 d、术后6个月接受超声检查.组织多普勒显像(TDI)测量左室12节段心肌收缩期达峰时间标准差(Ts-SD);心尖四腔观测量右室基底部横径(D1)、右室中部横径(D2)、右室长径(D3);2D-STI技术测量右心室游离壁基底段、中间段2个节段的收缩期峰值应变及应变率.结果 与CRT术前比较,CRT有反应组CRT术后6个月LVEDd、LVEDV、LVESV显著减小,LVEF显著增加,左室12节段Ts-SD显著减小,而CRT无反应组CRT术后6个月上述参数差异均无明显统计学意义;与CRT无反应组比较,CRT有反应组CRT术前右室径线D1、D2、D3无显著差别,而右室游离壁基底段、中段收缩期应变及应变率则显著较高;CRT有反应组术后6个月与CRT术前比较,右室径线D1、D2、D3显著减小,右室游离壁基底段、中间段收缩期应变及应变率显著增高,而CRT无反应组CRT术前后上述参数差异无统计学意义.CRT有反应组CRT术前后右室游离壁基底段、中间段收缩期应变及应变率均与左室12节段Ts-SD呈显著负相关.结论 CRT治疗能有效改善CHF患者右室重构及收缩功能,CRT术前将CHF患者右室功能指标纳入遴选标准可能有助于提高CRT治疗的有效性.