二维斑点追踪成像技术评价体外反搏后左室整体收缩功能的早期变化

摘要

Objective To explore the clinical value of two-dimensional speckle tracking imaging(2D-STI)in the early evaluation of left ventricular function changes after enhanced external counterpulsation treatment.Methods Twenty-six patients with refractory angina were enrolled by invitation and underwent a period of enhanced external counterpulsation(EECP) treatment.Echocardiography were performed before EECP,three weeks after EECP and after a period of EECP treatment. The mitral valve peak flow velocity of early diastole(E),peak flow velocity of atrial contraction(A),E/A ratio,left ventricular end-diastolic and end- systolic dimensions(LVEDD,LVESD),left ventricular end-diastolic and end- systolic volumes(LVEDV, LVESV),left ventricular systolic function(LVEF),and Tei index were measured using tissue Doppler imaging.The global systolic longitudinal strain(GLS)was assessed with 2D-STI.The rate of increase of Tei index(△Tei%) and GLS(△GLS%) after a period of EECP treatment were calculated.Results Only the absolute values of GLS was significantly increased after three weeks of EECP compared with that before EECP treatment,there was significant difference (P<0.05). Tei index was significantly reduced and the absolute values of GLS was significantly increased after a period of EECP (P<0.05).There was no difference of E/A, LVEDD,LVESD,LVEDV,LVESV and LVEF after three weeks and a period of EECP compared with before EECP treatment. There were significant negative correlation between △GLS% and △Tei%(r=-0.64,P<0.05).Conclusion Enhanced external counterpulsation treatment can improve left ventricular function in patients with refractory angina pectoris,2D-STI can evaluate the early changes of left ventricular global function after EECP objectively and quantitatively.%目的：探讨二维斑点追踪成像技术早期评价体外反搏治疗后左室功能变化的临床价值。方法26例难治性心绞痛患者接受增强型体外反搏治疗，分别于第一次反搏前、反搏3周后、一疗程反搏治疗结束后行超声心动图检查，测量二尖瓣口舒张早期和舒张晚期峰值流速（E、A），计算 E/A 值；测量左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）、左室舒张末容积（LVEDV）及收缩末容积（LVESV），并计算左室射血分数和左室 Tei 指数。应用2D-STI 获取左室整体纵向应变值（GLS），计算一个疗程反搏治疗后 Tei 指数增长率和 GLS 增长率。结果与第一次反搏前比较，反搏3周后仅 GLS 绝对值增大，差异有统计学意义（P<0.05）；一疗程反搏结束后 GLS 绝对值增大，Tei 指数减低，差异均有统计学意义（均 P<0.05）；与第一次反搏前比较，反搏3周及一疗程结束后 E/A 值、LVEDD、LVESD、LVEDV、LVESV 及左室射血分数差异均无统计学意义。 GLS 增长率与 Tei 指数增长率呈负相关（r=-0.64，P<0.05）。结论增强型体外反搏治疗可改善难治性心绞痛患者心功能；二维斑点追踪成像技术可以定量、客观地评价体外反搏后左室整体功能的早期变化。