实时三维超声心动图对冠状动脉粥样硬化性心脏病患者左室整体收缩功能与同步性的研究

摘要

目的 应用实时三维超声心动图(RT-3DE)检测冠状动脉粥样硬化性心脏病患者左室整体收缩功能和同步性的变化,探讨其临床应用价值.方法 46例心肌缺血患者(缺血组)、44例心肌梗死患者(梗死组)及60例健康志愿者(正常组)分别行RT-3DE检查,获取左室舒张末容积(3D-EDV)、左室收缩末容积(3D-ESV)及左室射血分数(3D-EF)等左室收缩功能参数,以及16、12节段达最小容积时间标准差和最大差的校正值(Tmsv-16-SD%、Tmsv-16-Dif%、Tmsv-12-SD%、Tmsv-12-Dif%)等同步性参数.结果 缺血组左室收缩功能指标(3D-EDV、3D-ESV、3D-EF)无明显改变,而校正的左室16及12节段收缩同步性参数(Tmsv-12-SD%、Tmsv-12-Dif%、Tmsv-16-SD%、Tmsv-16-Dif%)均明显延长,与正常组比较差异均有统计学意义(均P<0.05).梗死组左室收缩功能参数及校正的同步性参数与缺血组和正常组比较差异均有统计学意义(均P<0.05).梗死组左室校正的16及12节段收缩同步性参数均与3D-EF呈负相关,其中以Tmsv-16-SD%相关性最高(r=-0.732,P<0.01).结论 RT-3DE可早期客观评价缺血心肌左室收缩同步性,能准确测量梗死心肌左室收缩功能及同步性;左室不同步运动可影响左室收缩功能.%Objective To assess left ventricular(LV) global systolic function and synchrony in patients with coronary heart disease by real-time three-dimensional echocardiograph(RT-3DE). Methods Forty-six patients with myocardial ischemia(myocardial ischemia group), 44 patients with myocardial infarction(myocardial infarction group) and 60 healthy subjects(control group) were performed by RT-3DE,to obtain parameters of LV diastolic end volume(3D-EDV),LV end systolic volume(3D-ESV) and LV ejection fraction(3D-EF) and parameters of synchronization:the correction value of 16 and 12 segments up to minimum volume standand deviation (Tmsv-12-SD%,Tmsv-12-Dif%,Tmsv-16-SD%,Tmsv-16-Dif%). Results Compared with control group,3D-EDV,3D-ESV,3D-EF had no statistically significant differences in myocardial ischemia group,while Tmsv-l6-SD%,Tmsv-16-Dif%,Tmsv-12-SD%,Tmsv-12-Dif% were significantly delayer performed by RT-3DE (P<0.05).Compared with control group and myocardial ischemia group,the parameters of systolic function and synchrony all had statistically significant differences in myocardial infarction group (all P<0.05). The LVEF values were negative correlated with the systolic synchrony parameters,especially Tmsv-l6-SD%(r=-0.732,P<0.01).Conclusion RT-3DE can early assess LV systolic synchrony in patients with myocardial ischemia,and can accurately evaluate LV systolic function and systolic synchrony in patients with myocardial infarction. The LV systolic asynchrony has negatively effect on systolic function.