三维斑点追踪成像技术评价心脏再同步化治疗短期疗效的初步临床研究

摘要

Objective To assess left ventricular longitudinal strains (LS),radial strains(RS) and circumferential strains(CS) by using 2D speckle tracking (2DT) and 3D speckle tracking(3DT),and to explore the value of 3DT in the evaluation of cardiac resynchronization therapy (CRT) in clinic.Methods Echocardiography examination were performed in 18 congestive heart failure patients who received the CRT,before implantation,one week,two weeks,one month and three month after CRT operation respectively.The left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction (LVEF) were measured by 2D echocardiography.And then,LS,RS and CS were evaluated by 2DT and 3DT.Results Compared with before CRT implantation,RS in postoperative one week slightly improved by 3DT,and there wasn't any significant difference in the rest parameters.Two weeks after CRT,only RS,CS by 3DT and RS by 2DT were improved(P＜0.05).At the end of one and three months after CRT,all ultrasonic parameters were significant differences compared with those before CRT.No significant difference in the intraobserver and interobserver coefficient variation was observed by 3DT and 2DT.Conclusions 3DT could be used to detect left ventricular function change effectively and could be used to evaluate the short-term efficacy of CRT therapy.%目的 应用三维斑点追踪技术(3DT)和二维斑点追踪技术(2DT)评价左心室心肌纵向、圆周和径向应变,探讨3DT在评价心脏再同步化治疗(CRT)短期疗效中的临床应用价值.方法 接受CRT治疗的心力衰竭患者18例,分别于起搏器植入术前、术后1周、术后2周、术后1个月、术后3个月进行常规超声测量左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)和射血分数(LVEF)；2DT和3DT分别分析左心室心肌16节段纵向应变(LS)、圆周应变(CS)和径向应变(RS).结果 与术前比较,术后1周3DT测得的RS较术前稍有改善(P＜0.05),其余参数较术前差异无统计学意义(P＞0.05)；术后2周,3DT测得的RS、CS及2DT测得的RS较术前改善(P＜0.05),其余参数较术前差异无统计学意义(P＞0.05)；术后1个月及术后3个月,两种方法测得的LS、CS、RS及其他参数较术前差异均有统计学意义(P＜0.05).两种方法测得左心室纵向、圆周和径向应变的观察者内和观察者间的变异系数之间差异无统计学意义(P＞0.05).结论 CRT近期即可较明显改善心力衰竭患者的心功能.3DT能有效观察左心室功能的变化,可用于评价CRT治疗的短期效果.