应用三维斑点追踪成像技术评价心脏再同步化治疗的短期疗效

摘要

Objective: To assess the short-term effects of cardiac resynchronization therapy (CRT) via three-dimensional speckle tracking imaging (3D-STI). Methods: Fifteen congestive heart failure patients who underwent CRT and twenty normal volunteers were enrolled. Toshiba Artida 4D system with PST-25SX probe were used to perform 3D-STI in heart failure patients and the controls,and the heart failure patients were studied before and one week,one month,three months after CRT. The left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction (LVEF) were obtained. The left ventricular dyssynchrony data sets which include the standard deviation of time to peak area tracking in the 16 left ventricular segments (AT-SD) and the maximum difference of time to peak area tracking in the 16 left ventricular segments (AT-Dif) were also investigated. Two independent samples t test and the ANOVA for one group repeated measures were used to perform the data analysis. Results: Compared with the controls,LVEDV,LVESV,AT-SD and AT-Dif of the heart failure patients were significantly bigger,and LVEF of the heart failure patients were significantly smaller(P<0.05). One week after CRT,the left ventricular dyssynchrony data sets were decreased(P<0.0083); after that,the changes of left ventricular dyssynchrony data sets were not statistically significant (P>0.0083). LVEDV,LVESV descended with the time (P<0.0083); LVEF ascended with the time(P>0.0083). Conclusion: 3D-STI provides valuable information to assess the curative effect of CRT.%目的:探讨三维斑点追踪成像(Three-dimensional speckle tracking imaging,3D-STI)技术评价心脏再同步化治疗(Cardiac resynchronization therapy,CRT)短期疗效的临床价值.方法:充血性心力衰竭患者15例(心衰组)和正常志愿者20例(对照组),其中心衰组分别于CRT术前、术后1周、术后1月和术后3月,应用3D-STI测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)和左心室不同步性参数,即左心室16个节段的面积追踪达峰时间标准差(AT-SD)和达峰时间最大差值(AT-Dif).统计学方法采用两独立样本的t检验和单组重复测量资料的方差分析.结果:心衰患者CRT术前LVEDV、LVESV、AT-SD、AT-Dif大于对照组,心衰患者CRT术前LVEF低于对照组,差异均有统计学意义(P＜0.05).心衰患者术后1周时左心室的AT-SD、AT-Dif均较术前明显减小(P＜0.0083),术后1周以后左心室不同步性无进一步改善(P＞0.0083).LVEDV、LVESV随时间延长逐渐下降(P＜0.0083),LVEF随时间延长逐渐增加(P＜0.0083).结论:3D-STI为评价CRT的短期疗效提供了有价值的信息.